Provider Demographics
NPI:1497530836
Name:PROGRESSIVE REHABILITATION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PROGRESSIVE REHABILITATION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIJO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:845-270-0855
Mailing Address - Street 1:156 LAKE NANUET DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3516
Mailing Address - Country:US
Mailing Address - Phone:845-270-0855
Mailing Address - Fax:
Practice Address - Street 1:156 LAKE NANUET DR
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3516
Practice Address - Country:US
Practice Address - Phone:845-270-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy