Healthcare Provider Details

I. General information

NPI: 1851666440
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 JOHNNIE DODDS BLVD
MT PLEASANT SC
29464-3030
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2619
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-6889
  • Fax: 843-856-0128
Mailing address:
  • Phone: 803-758-2600
  • Fax: 803-253-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BARRY FITCH
Title or Position: PRESIDENT
Credential: DPT
Phone: 803-731-4055