Healthcare Provider Details

I. General information

NPI: 1053301341
Provider Name (Legal Business Name): PROGRESS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3076 NORTHRIDGE RD
HALE MI
48739-9277
US

IV. Provider business mailing address

3076 NORTHRIDGE RD
HALE MI
48739-9277
US

V. Phone/Fax

Practice location:
  • Phone: 989-728-0242
  • Fax: 989-728-1144
Mailing address:
  • Phone: 989-728-0242
  • Fax: 989-728-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501008794
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SHIVAKUMAR SUBBARAYAN
Title or Position: PRESIDENT
Credential: RPT
Phone: 989-728-0242