Healthcare Provider Details

I. General information

NPI: 1619350568
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 HIGHWAY 17 N
NORTH MYRTLE BEACH SC
29582-2938
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2619
US

V. Phone/Fax

Practice location:
  • Phone: 843-491-2041
  • Fax: 843-272-1344
Mailing address:
  • Phone: 803-758-2602
  • 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 Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

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