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NPI Code Detail

MEDICARE: PROGRESSIVE PHYSICAL THERAPY SERVICE INC.

MEDICARE: PROGRESSIVE PHYSICAL THERAPY SERVICE 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
12251X0800XOrthopedic Physical Therapist7920FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y911KOTHERFLBC/BS

General Provider Information

NPI Number : 1043261233
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE PHYSICAL THERAPY SERVICE INC.
Provider Business Mailing Address
First Line : 17751 MURDOCK CIR
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33948-1034
Country : US
Telephone Number : 941-743-8700
Fax Number : 941-743-8850
Provider Business Practice Location Address
First Line : 17751 MURDOCK CIR
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33948-1034
Country : US
Telephone Number : 941-743-8700
Fax Number : 941-743-8850
Authorized Official
Title or Position : PRESIDENT
Name : MR. WAYNE GOFFIN
Credential :
Telephone Number : 941-743-8700
Provider Enumeration Date : 05/13/2006
Last Update Date : 08/22/2020

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Directions to “PROGRESSIVE PHYSICAL THERAPY SERVICE INC. ” Practice Location

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