Healthcare Provider Details

I. General information

NPI: 1669128476
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WHITLOCK PLACE STE F
MARIETTA GA
30064
US

IV. Provider business mailing address

PO BOX 675161 3000 WINDY HILL RD. STE T5
MARIETTA GA
30067-9997
US

V. Phone/Fax

Practice location:
  • Phone: 770-765-3303
  • Fax: 470-437-3222
Mailing address:
  • Phone: 770-765-3303
  • Fax: 470-437-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE CROWELL
Title or Position: OWNER/LEAD PHYSICAL THERAPIST
Credential: DPT
Phone: 770-765-3303