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General NPI Number Information
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NPI Number | 1942437165
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHYSICAL THERAPY AND REHABILITATION
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 16545 GOLDENCREST CIR
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City | PURCELLVILLE
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State | VA
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Zip | 20132-9654
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Country | US
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Telephone | 540-338-2827
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Fax |
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Provider Business Mailing Address
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Address Line | 16545 GOLDENCREST CIR
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City | PURCELLVILLE
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State | VA
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Zip | 20132-9654
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Country | US
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Telephone | 540-338-9489
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC INGOLD
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Credential |
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Telephone | 540-338-2827
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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 | 2305202442
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License Number State | VA
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