Provider Demographics
NPI:1134718257
Name:PROGRESSIVE REHABILITATIVE SERVICES, PLLC
Entity type:Organization
Organization Name:PROGRESSIVE REHABILITATIVE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-424-3181
Mailing Address - Street 1:860 HIGHWAY 62 E STE 10
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3200
Mailing Address - Country:US
Mailing Address - Phone:870-424-3181
Mailing Address - Fax:870-424-3089
Practice Address - Street 1:4313 S PLEASANT CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1347
Practice Address - Country:US
Practice Address - Phone:870-424-3181
Practice Address - Fax:870-424-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC-3481OtherARKANSAS MEDICAL BOARD