Provider Demographics
NPI:1760434948
Name:PROGRESS REHABILITATION NETWORK LLC
Entity Type:Organization
Organization Name:PROGRESS REHABILITATION NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR/MANAGING PARTNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ORRISON
Authorized Official - Last Name:PUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:804-756-8495
Mailing Address - Street 1:5300 HICKORY PARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2629
Mailing Address - Country:US
Mailing Address - Phone:804-756-8495
Mailing Address - Fax:804-270-7756
Practice Address - Street 1:5300 HICKORY PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2629
Practice Address - Country:US
Practice Address - Phone:804-756-8495
Practice Address - Fax:804-270-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09882Medicare PIN
DCG02796Medicare PIN