MEDICARE: PROGRESS PHYSICAL THERAPY NETWORK 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1063641678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS PHYSICAL THERAPY NETWORK INC

Provider Business Mailing Address
First Line	:	565 PROGRESS ST STE C
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-8601
Country	:	US
Telephone Number	:	989-345-4300
Fax Number	:	989-345-9644

Provider Business Practice Location Address
First Line	:	565 PROGRESS ST STE C
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-8601
Country	:	US
Telephone Number	:	989-345-4300
Fax Number	:	989-345-9644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHIVAKUMAR SUBBARAYAN
Credential	:	RPT
Telephone Number	:	989-345-4300

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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