MEDICARE: PROGRESSIVE REHAB AND HOME CARE PT & OT, PLLC

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	023107	NY
2	225X00000X	Occupational Therapist	014057	NY

General Provider Information

NPI Number	:	1093084634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE REHAB AND HOME CARE PT & OT, PLLC

Provider Business Mailing Address
First Line	:	143 E RIDGEWOOD AVE UNIT 309
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07451-7015
Country	:	US
Telephone Number	:	201-803-7008
Fax Number	:	201-786-9222

Provider Business Practice Location Address
First Line	:	4121 28TH ST APT 14C
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3766
Country	:	US
Telephone Number	:	201-803-7008
Fax Number	:	201-786-9222

Authorized Official
Title or Position	:	OWNER
Name	:	MAHROS K ISAAC
Credential	:	PT
Telephone Number	:	201-803-7008

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	03/11/2026

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