MEDICARE: PROGRESSIVE PHYSICAL THERAPY

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	225100000X	Physical Therapist	1424	AR
2	225100000X	Physical Therapist	1073	AR

General Provider Information

NPI Number	:	1023045705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 489
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72115-0489
Country	:	US
Telephone Number	:	501-753-5189
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W PERSHING BLVD
Second Line	:	SUITE D
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2147
Country	:	US
Telephone Number	:	501-753-5189
Fax Number	:	501-753-0255

Authorized Official
Title or Position	:	OWNER/ PHYSICAL THERAPIST
Name	:	STEPHEN EDWARD MCDONALD
Credential	:	P.T.
Telephone Number	:	501-753-5189

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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Directions to “PROGRESSIVE PHYSICAL THERAPY ” Practice Location

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