Provider Demographics
NPI:1821216466
Name:PROGRESSIVE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIS
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-640-1855
Mailing Address - Street 1:321 N PINES RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5176
Mailing Address - Country:US
Mailing Address - Phone:509-228-9404
Mailing Address - Fax:509-228-9403
Practice Address - Street 1:321 N PINES RD STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5176
Practice Address - Country:US
Practice Address - Phone:509-228-9404
Practice Address - Fax:509-228-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006435261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8318479Medicaid
WA8804837Medicare ID - Type Unspecified