Healthcare Provider Details

I. General information

NPI: 1376681221
Provider Name (Legal Business Name): PROGRESSIVE REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 SCHERM RD STE 1
OWENSBORO KY
42301-5300
US

IV. Provider business mailing address

1605 SCHERM RD STE 1
OWENSBORO KY
42301-5300
US

V. Phone/Fax

Practice location:
  • Phone: 270-685-9499
  • Fax: 270-852-5277
Mailing address:
  • Phone: 270-685-9499
  • Fax: 270-852-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. TRISHA JENELL PHELPS
Title or Position: PREISDENT
Credential: OT
Phone: 270-688-8559