Provider Demographics
NPI:1447379748
Name:PROGRESS REHABILITATION NETWORK, LLC
Entity type:Organization
Organization Name:PROGRESS REHABILITATION NETWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ORRISON
Authorized Official - Last Name:PUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-756-8495
Mailing Address - Street 1:19441 GOLF VISTA PLAZA
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8271
Mailing Address - Country:US
Mailing Address - Phone:703-724-7474
Mailing Address - Fax:703-724-9232
Practice Address - Street 1:19441 GOLF VISTA PLAZA
Practice Address - Street 2:SUITE 230
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8271
Practice Address - Country:US
Practice Address - Phone:703-724-7474
Practice Address - Fax:703-724-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty