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General NPI Number Information
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NPI Number | 1154536860
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE REHAB, LLC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 2305 N. BROAD STREET LOWER LEVEL
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City | PHILADELPHIA
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State | PA
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Zip | 19132
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Country | US
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Telephone | 215-223-6548
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Fax | 215-245-5615
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Provider Business Mailing Address
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Address Line | PO BOX 755
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City | AMBLER
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State | PA
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Zip | 19002-0755
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Country | US
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Telephone | 215-223-6548
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Fax | 215-245-5615
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Authorized Official
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Title or Position | PARTNER
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Name | JENNIFER GUARNACCIA
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Credential |
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Telephone | 215-223-6548
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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 | PT004092L
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License Number State | PA
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