Provider Demographics
NPI:1487883468
Name:PROGRESSIVE SPORTS REHABILITATION
Entity type:Organization
Organization Name:PROGRESSIVE SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-820-4608
Mailing Address - Street 1:194 STATE RT 17 N
Mailing Address - Street 2:D
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4006
Mailing Address - Country:US
Mailing Address - Phone:201-820-4608
Mailing Address - Fax:201-820-4611
Practice Address - Street 1:194 STATE RT 17 N
Practice Address - Street 2:D
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4006
Practice Address - Country:US
Practice Address - Phone:201-820-4608
Practice Address - Fax:201-820-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01153800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy