Healthcare Provider Details

I. General information

NPI: 1669975496
Provider Name (Legal Business Name): PROGRESSIVE REHABILITATION SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 CHESWICK LN
MOUNT PLEASANT SC
29466-8638
US

IV. Provider business mailing address

2494 CHESWICK LN
MOUNT PLEASANT SC
29466-8638
US

V. Phone/Fax

Practice location:
  • Phone: 215-534-2381
  • Fax:
Mailing address:
  • Phone: 215-534-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3143
License Number StateSC

VIII. Authorized Official

Name: MR. STEVEN BEVILACQUA
Title or Position: MBR
Credential: PTA
Phone: 215-534-2381