Provider Demographics
NPI:1922010602
Name:PROGRESSIVE REHABILITATION ORTHOPEDIC THERAPY, INC
Entity Type:Organization
Organization Name:PROGRESSIVE REHABILITATION ORTHOPEDIC THERAPY, INC
Other - Org Name:PROGRESSIVE REHABILITATION ORTHOPEDIC THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TWOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-854-4776
Mailing Address - Street 1:1948 MESQUITE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5777
Mailing Address - Country:US
Mailing Address - Phone:928-854-4776
Mailing Address - Fax:928-854-4857
Practice Address - Street 1:1948 MESQUITE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5777
Practice Address - Country:US
Practice Address - Phone:928-854-4776
Practice Address - Fax:928-854-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ70250Medicare ID - Type UnspecifiedMCR GROUP NUMBER