MEDICARE: PROGRESSUS THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1710113162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSUS THERAPY

Provider Business Mailing Address
First Line	:	5384 VEGAS DR # 1247
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2347
Country	:	US
Telephone Number	:	800-892-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	5384 VEGAS DR # 1247
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2347
Country	:	US
Telephone Number	:	800-892-0640
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JASON T RALPH
Credential	:
Telephone Number	:	800-434-4686

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	11/29/2018

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Directions to “PROGRESSUS THERAPY ” Practice Location

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