Provider Demographics
NPI:1568657617
Name:PROGRESSIONAL REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:PROGRESSIONAL REHABILITATION CENTER INC
Other - Org Name:PROGRESSIONAL REHABILITATION INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABARLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:931-879-4301
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-1170
Mailing Address - Country:US
Mailing Address - Phone:931-879-4301
Mailing Address - Fax:931-879-4302
Practice Address - Street 1:403 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-1170
Practice Address - Country:US
Practice Address - Phone:931-879-4301
Practice Address - Fax:931-879-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0063840OtherBCBSTN
TN4448120Medicaid
TN446526Medicare Oscar/Certification