Basic Information
| Provider Information | |||||||||
| NPI: | 1962852863 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROGRESSIVE SPECIALTY THERAPY SERVICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROGRESSIVE SPECIALTY THERAPY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 17TH ST | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953541209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095051035 | ||||||||
| FaxNumber: | 2098460345 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 17TH ST | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953541209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095051035 | ||||||||
| FaxNumber: | 2098460345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2092487851 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.