Provider Demographics
NPI:1396778528
Name:PROGRESSIVE REHAB CENTER CORP
Entity type:Organization
Organization Name:PROGRESSIVE REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-5098
Mailing Address - Street 1:1800 W 68 STREET
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-827-5098
Mailing Address - Fax:
Practice Address - Street 1:1800 W 68 STREET
Practice Address - Street 2:SUITE 117
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-827-5098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684528Medicare ID - Type UnspecifiedTHERAPY CENTER