Basic Information
| Provider Information | |||||||||
| NPI: | 1679104632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 392573 | ||||||||
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| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152519573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243434060 | ||||||||
| FaxNumber: | 7243434069 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 N PITT ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223141564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703122294 | ||||||||
| FaxNumber: | 5719824132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | LAU | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7249894564 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.