Basic Information
| Provider Information | |||||||||
| NPI: | 1437825296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE SPORTS THERAPY, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 SCHERM RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1605 SCHERM RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706859499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | PHELPS | ||||||||
| AuthorizedOfficialFirstName: | TRISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2706859499 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.