1750059127 NPI number — PROGRESSIVE REHAB OF PA, INC.

Table of content: (NPI 1750059127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750059127 NPI number — PROGRESSIVE REHAB OF PA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE REHAB OF PA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750059127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5243 LITTLE DEBBIE PKWY STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OOLTEWAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37363-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
40-423-3500
Provider Business Mailing Address Fax Number:
404-233-9021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 E HARFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18337-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-296-5156
Provider Business Practice Location Address Fax Number:
570-296-2592
Provider Enumeration Date:
09/01/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
PHIL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
404-233-6500

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)