Provider Demographics
NPI:1972785905
Name:PROGRESSIVE REHABILITATION MEDICINE, PC
Entity type:Organization
Organization Name:PROGRESSIVE REHABILITATION MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MD
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-393-1320
Mailing Address - Street 1:6005 ROCKWELL DR NE STE B
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7228
Mailing Address - Country:US
Mailing Address - Phone:319-393-1320
Mailing Address - Fax:319-393-1350
Practice Address - Street 1:6005 ROCKWELL DR NE STE B
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-393-1320
Practice Address - Fax:319-393-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADE2425OtherRR MEDICARE
IADE2425OtherRR MEDICARE
IAI16226Medicare PIN