Healthcare Provider Details

I. General information

NPI: 1992391148
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 TERRACE BLVD
NEW HYDE PARK NY
11040-4330
US

IV. Provider business mailing address

103 TERRACE BLVD
NEW HYDE PARK NY
11040-4330
US

V. Phone/Fax

Practice location:
  • Phone: 347-819-1531
  • Fax: 718-504-6464
Mailing address:
  • Phone: 347-819-1531
  • Fax: 718-504-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERICSON NAVARRO
Title or Position: PRESIDENT
Credential: PT
Phone: 347-819-1531