Provider Demographics
NPI:1871588624
Name:PROGRESSIVE PHYSICAL THERAPY CENTER INC
Entity type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-232-9222
Mailing Address - Street 1:12651 S DIXIE HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5975
Mailing Address - Country:US
Mailing Address - Phone:305-232-9222
Mailing Address - Fax:305-232-8808
Practice Address - Street 1:12651 S DIXIE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5975
Practice Address - Country:US
Practice Address - Phone:305-232-9222
Practice Address - Fax:305-232-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9372, PT8934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY913BOtherBCBS FL
FL102579OtherAVMED
FL9434690OtherCIGNA
FL102579OtherAVMED