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	:	1265011175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 392573
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-9500
Country	:	US
Telephone Number	:	724-343-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	9923 STEPHEN DECATUR HWY STE D1
Second Line	:
City	:	OCEAN CITY
State	:	MD
Zip	:	21842-9658
Country	:	US
Telephone Number	:	410-390-3490
Fax Number	:	410-390-3525

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	LAUREN LAU
Credential	:
Telephone Number	:	888-644-7747

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	01/10/2022

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