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General NPI Number Information
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NPI Number | 1093084634
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE REHAB AND HOME CARE PT & OT, PLLC
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 537 BANTA ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-1918
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Country | US
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Telephone | 201-803-7008
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Fax | 201-786-9222
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Provider Business Mailing Address
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Address Line | 537 BANTA ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-1918
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Country | US
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Telephone | 201-803-7008
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Fax | 201-786-9222
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Authorized Official
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Title or Position | OWNER
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Name | MAHROS K ISAAC
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Credential | PT
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Telephone | 201-803-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 023107
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 014057
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License Number State | NY
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