Provider Demographics
NPI:1124142799
Name:PROGRESSIVE REHABILITATION AGENCY, INC.
Entity type:Organization
Organization Name:PROGRESSIVE REHABILITATION AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-955-1239
Mailing Address - Street 1:2999 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5141
Mailing Address - Country:US
Mailing Address - Phone:941-955-1239
Mailing Address - Fax:941-955-1089
Practice Address - Street 1:2999 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5141
Practice Address - Country:US
Practice Address - Phone:941-955-1239
Practice Address - Fax:941-955-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106621261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR08OtherBCBS PROVIDER NUMBER
FLR08OtherBCBS PROVIDER NUMBER