Basic Information
| Provider Information | |||||||||
| NPI: | 1376681221 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE REHAB, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 SCHERM RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706859499 | ||||||||
| FaxNumber: | 2708525277 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 SCHERM RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706859499 | ||||||||
| FaxNumber: | 2708525277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | PHELPS | ||||||||
| AuthorizedOfficialFirstName: | TRISHA | ||||||||
| AuthorizedOfficialMiddleName: | JENELL | ||||||||
| AuthorizedOfficialTitleorPosition: | PREISDENT | ||||||||
| AuthorizedOfficialTelephone: | 2706888559 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 251E00000X | N | Agencies | Home Health | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.