Healthcare Provider Details

I. General information

NPI: 1588967392
Provider Name (Legal Business Name): PROGRESSIVEHEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROSENBERGER AVE
EVANSVILLE IN
47712-6503
US

IV. Provider business mailing address

150 N ROSENBERGER AVE
EVANSVILLE IN
47712-6503
US

V. Phone/Fax

Practice location:
  • Phone: 812-491-3856
  • Fax: 812-491-1269
Mailing address:
  • Phone: 812-491-3856
  • Fax: 812-491-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH R BERSCH
Title or Position: CEO
Credential:
Phone: 812-491-3856