Organization
PROGRESSIVE SPORTS MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J. GRAVELEY MD (OWNER)
(610) 444-5406
Entity
Organization
Contact information
Practice address
404 MCFARLAN RD, SUITE 201, KENNETT SQUARE, PA 19348-2479
(610) 444-5406
(610) 444-5907
Mailing address
404 MCFARLAN RD, SUITE 201, KENNETT SQUARE, PA 19348-2479
(610) 444-5406
(610) 444-5907
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101967721-0001
—
PA
Enumeration date
05/03/2007
Last updated
04/14/2008
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