MEDICARE: PROGRESSIVE PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	HCC5366	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6457550001	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1013088962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	SUITE B-2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-898-0443
Fax Number	:	386-898-0459

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	SUITE B-2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-898-0443
Fax Number	:	386-898-0459

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, PRESIDENT
Name	:	DR. CHARLES LAWRENCE PIAZZA JR.
Credential	:	DPT, ATC, MTC
Telephone Number	:	386-898-0443

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/19/2011

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