Provider Demographics
NPI:1548727019
Name:PROGRESSIVE REHAB AND WELLNESS
Entity type:Organization
Organization Name:PROGRESSIVE REHAB AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:828-449-4804
Mailing Address - Street 1:458 ANVIL DRAW PL
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-9236
Mailing Address - Country:US
Mailing Address - Phone:803-577-3701
Mailing Address - Fax:
Practice Address - Street 1:403 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2321
Practice Address - Country:US
Practice Address - Phone:803-416-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty