MEDICARE: PROGRESSIVE PHYSICAL THERAPY, PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225XH1200X	Hand Occupational Therapist
3	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700151313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PHYSICAL THERAPY, PA

Provider Business Mailing Address
First Line	:	1818 HENDERSON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2619
Country	:	US
Telephone Number	:	803-758-2600
Fax Number	:	803-253-8896

Provider Business Practice Location Address
First Line	:	2050 CORPORATE CENTRE DR
Second Line	:	SUITE 100
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-7428
Country	:	US
Telephone Number	:	843-443-9368
Fax Number	:	843-916-2348

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARRY E FITCH
Credential	:	DPT
Telephone Number	:	803-731-4055

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	07/09/2015

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Directions to “PROGRESSIVE PHYSICAL THERAPY, PA ” Practice Location

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