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General NPI Number Information
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NPI Number | 1407292295
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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 | 05/20/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 18566 OFFICE PARK DR
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20886-0587
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Country | US
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Telephone | 301-519-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 18527 RELIANT DR
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City | GAITHERSBURG
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State | MD
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Zip | 20879-5419
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Country | US
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Telephone | 301-526-3972
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Fax |
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Authorized Official
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Title or Position | P.T.
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Name | MR. ILYAS H ZAIDI
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Credential | P.T.
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Telephone | 301-519-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 20105
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License Number State | MD
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