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General NPI Number Information
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NPI Number | 1669128476
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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 | 03/02/2022
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 60 WHITLOCK PLACE STE F
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City | MARIETTA
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State | GA
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Zip | 30064
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Country | US
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Telephone | 770-765-3303
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Fax | 470-437-3222
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Provider Business Mailing Address
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Address Line | PO BOX 675161 3000 WINDY HILL RD. STE T5
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City | MARIETTA
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State | GA
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Zip | 30067-9997
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Country | US
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Telephone | 770-765-3303
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Fax | 470-437-3222
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Authorized Official
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Title or Position | OWNER/LEAD PHYSICAL THERAPIST
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Name | MRS. JACQUELINE CROWELL
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Credential | DPT
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Telephone | 770-765-3303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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