1780901793 NPI number — PROGRESSIVE PHYSICAL THERAPY

Table of content: (NPI 1780901793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780901793 NPI number — PROGRESSIVE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE PHYSICAL THERAPY
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:
1780901793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 K ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99501-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-748-0022
Provider Business Mailing Address Fax Number:
907-277-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 K ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99501-3318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-748-0022
Provider Business Practice Location Address Fax Number:
907-277-0022
Provider Enumeration Date:
04/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
TARAH
Authorized Official Middle Name:
ADRIENNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-748-0022

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1529 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1639466378 . This is a "GROUP PROVIDER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1881981546 . This is a "GROUP PROVIDER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1740594183 . This is a "GROUP PROVIDER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1134246945 . This is a "GROUP PROVIDER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1713211 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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