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General NPI Number Information
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NPI Number | 1538228762
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHYSICAL THERAPY PLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 4120 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1281
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Country | US
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Telephone | 616-534-0366
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Fax | 616-534-0540
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Provider Business Mailing Address
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Address Line | 4120 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1281
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Country | US
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Telephone | 616-534-0366
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Fax | 616-534-0540
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Authorized Official
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Title or Position | MEMBER
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Name | MR. RONALD JAY KRONEMEYER
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Credential | P.T.
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Telephone | 616-534-0366
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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 | 5501001107
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License Number State | MI
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