| Organization Name: | PROGRESSIVE SPORTS REHABILITATION |
| NPI Number: | 1487883468 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES A SWINKIN (DPT/OWNER) |
| Mailing Address: | 194 State Rt 17 N D Rochelle Park |
| State: | NJ US |
| Postal Code: | 076624006 |
| Phone Number: | 2018204608 |
| Fax Number: | 2018204611 |
| NPI Enumeration Date: | 07/10/2009 |
| NPI Last Update Date: | 07/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 40QA01153800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |