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General NPI Number Information
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NPI Number | 1669975496
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE REHABILITATION SOLUTIONS LLC
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 2494 CHESWICK LN
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-8638
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Country | US
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Telephone | 215-534-2381
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Fax |
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Provider Business Mailing Address
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Address Line | 2494 CHESWICK LN
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-8638
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Country | US
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Telephone | 215-534-2381
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | MR. STEVEN BEVILACQUA
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Credential | PTA
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Telephone | 215-534-2381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3143
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License Number State | SC
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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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