Provider Demographics
NPI:1013088962
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 THERAPIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, ATC, MTC
Authorized Official - Phone:386-898-0443
Mailing Address - Street 1:290 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8130
Mailing Address - Country:US
Mailing Address - Phone:386-898-0443
Mailing Address - Fax:386-898-0459
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B-2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-898-0443
Practice Address - Fax:386-898-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5366261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6457550001OtherPTAN