Basic Information
| Provider Information | |||||||||
| NPI: | 1134718257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE REHABILITATIVE SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 HIGHWAY 62 E STE 10 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726533200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704243181 | ||||||||
| FaxNumber: | 8704243089 | ||||||||
| Practice Location | |||||||||
| Address1: | 4313 S PLEASANT CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704243181 | ||||||||
| FaxNumber: | 8704243089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2021 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARDIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8704243181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | MC-3481 | 01 | ARKANSAS MEDICAL BOARD | OTHER |