Healthcare Provider Details

I. General information

NPI: 1912936840
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY AND REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W WILSON ST STE 202
COSTA MESA CA
92627-1586
US

IV. Provider business mailing address

129 W WILSON ST STE 202
COSTA MESA CA
92627-1586
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-0125
  • Fax: 949-631-0127
Mailing address:
  • Phone: 949-631-0125
  • Fax: 949-631-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25272
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13058
License Number StateCA

VIII. Authorized Official

Name: MICHAEL MCKINDLEY
Title or Position: OWNER
Credential:
Phone: 949-631-0125