Provider Demographics
NPI:1851585566
Name:PROGRESSIVE PHYSICAL THERAPY SOLUTIONS
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-318-7728
Mailing Address - Street 1:4070 RIVIERA DR
Mailing Address - Street 2:#9
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5380
Mailing Address - Country:US
Mailing Address - Phone:619-318-7728
Mailing Address - Fax:858-200-7785
Practice Address - Street 1:4070 RIVIERA DR
Practice Address - Street 2:#9
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5380
Practice Address - Country:US
Practice Address - Phone:619-318-7728
Practice Address - Fax:858-200-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21798261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19692Medicare PIN