Provider Demographics
NPI:1013934199
Name:PROGRESSIVE REHABILITATION
Entity type:Organization
Organization Name:PROGRESSIVE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-426-5888
Mailing Address - Street 1:PO BOX 633138
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3138
Mailing Address - Country:US
Mailing Address - Phone:859-781-2800
Mailing Address - Fax:859-781-3500
Practice Address - Street 1:1400 GLORIA TERRELL DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076
Practice Address - Country:US
Practice Address - Phone:859-781-2800
Practice Address - Fax:859-781-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8790062700Medicaid
KY0171Medicare PIN