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General NPI Number Information
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NPI Number | 1114532348
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Entity Type | Organization
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Legal Business Name | PROGRESSIVEHEALTH REHABILITATION SOLUTIONS, INC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 2939 OLD CANTON RD STE A
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City | JACKSON
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State | MS
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Zip | 39216-4211
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Country | US
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Telephone | 601-203-3706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6890
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City | EVANSVILLE
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State | IN
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Zip | 47719-0890
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Country | US
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Telephone | 812-491-3856
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEITH BERSCH
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Credential |
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Telephone | 812-491-3856
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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 |
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License Number State |
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