MEDICARE: PROGRESSIVE PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1154021210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	2000 WESTINGHOUSE DR STE 200
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5238
Country	:	US
Telephone Number	:	724-343-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	8141 RITCHIE HWY STE A
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-6928
Country	:	US
Telephone Number	:	443-906-0181
Fax Number	:	443-901-3877

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MELANIE REDFERN
Credential	:
Telephone Number	:	412-567-2400

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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