Provider Demographics
NPI:1538486709
Name:PROGRESSIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-375-4639
Mailing Address - Street 1:504A MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2111
Mailing Address - Country:US
Mailing Address - Phone:802-375-4639
Mailing Address - Fax:802-442-6423
Practice Address - Street 1:504A MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2111
Practice Address - Country:US
Practice Address - Phone:802-375-4639
Practice Address - Fax:802-442-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0017370Medicare PIN