Provider Demographics
NPI:1780901793
Name:PROGRESSIVE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARAH
Authorized Official - Middle Name:ADRIENNE
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-748-0022
Mailing Address - Street 1:718 K ST STE D
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3318
Mailing Address - Country:US
Mailing Address - Phone:907-748-0022
Mailing Address - Fax:907-277-0022
Practice Address - Street 1:718 K ST STE D
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3318
Practice Address - Country:US
Practice Address - Phone:907-748-0022
Practice Address - Fax:907-277-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1639466378OtherGROUP PROVIDER
AK1881981546OtherGROUP PROVIDER
AK1740594183OtherGROUP PROVIDER
AK1134246945OtherGROUP PROVIDER
AK1713211Medicaid