Provider Demographics
NPI:1053944009
Name:PROGRESSIVE REHAB MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:PROGRESSIVE REHAB MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:OLAKUNLE
Authorized Official - Last Name:OLADOSU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-922-4222
Mailing Address - Street 1:15 PITCHPINE PL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4208
Mailing Address - Country:US
Mailing Address - Phone:347-922-4222
Mailing Address - Fax:631-569-5718
Practice Address - Street 1:15 PITCHPINE PL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4208
Practice Address - Country:US
Practice Address - Phone:347-922-4222
Practice Address - Fax:631-569-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty