Healthcare Provider Details

I. General information

NPI: 1023362555
Provider Name (Legal Business Name): PROGRESSIONS THERAPY @ COPPER MOUNTAIN INN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MONROE ST
GLOBE AZ
85501-1363
US

IV. Provider business mailing address

1100 E MONROE ST
GLOBE AZ
85501-1363
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-5721
  • Fax: 928-425-3745
Mailing address:
  • Phone: 928-425-5721
  • Fax: 928-425-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberOTC3084
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOTC3084
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOTC3084
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberOTC3084
License Number StateAZ

VIII. Authorized Official

Name: PAULA MITCHELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-425-5721