Healthcare Provider Details

I. General information

NPI: 1487531869
Provider Name (Legal Business Name): PROGRESS PIVOT THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14542 VENTURA BLVD STE 214
SHERMAN OAKS CA
91403-5523
US

IV. Provider business mailing address

14542 VENTURA BLVD STE 214
SHERMAN OAKS CA
91403-5523
US

V. Phone/Fax

Practice location:
  • Phone: 747-966-7623
  • Fax:
Mailing address:
  • Phone: 818-966-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEKSEY NISIS
Title or Position: CEO
Credential:
Phone: 747-966-7623