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General NPI Number Information
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NPI Number | 1275164121
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 416 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4511
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Country | US
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Telephone | 703-817-2914
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Fax | 702-817-2916
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Provider Business Mailing Address
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Address Line | PO BOX 392573
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City | PITTSBURGH
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State | PA
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Zip | 15251-9573
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Country | US
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Telephone | 724-584-5739
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Fax | 724-343-4069
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | LAUREN LAU
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Credential |
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Telephone | 724-989-4564
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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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