Provider Demographics
NPI:1992391148
Name:PROGRESSIVE PHYSICAL THERAPY SERVICES, PC
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-819-1531
Mailing Address - Street 1:103 TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4330
Mailing Address - Country:US
Mailing Address - Phone:347-819-1531
Mailing Address - Fax:718-504-6464
Practice Address - Street 1:103 TERRACE BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4330
Practice Address - Country:US
Practice Address - Phone:347-819-1531
Practice Address - Fax:718-504-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty