Healthcare Provider Details

I. General information

NPI: 1457778946
Provider Name (Legal Business Name): PROGRESSIVE THEARPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W BRANDON BLVD SUITE 210
BRANDON FL
33511-5104
US

IV. Provider business mailing address

220 W BRANDON BLVD SUITE 210
BRANDON FL
33511-5104
US

V. Phone/Fax

Practice location:
  • Phone: 813-525-5468
  • Fax: 813-438-8903
Mailing address:
  • Phone: 813-525-5468
  • Fax: 813-438-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. STACEY DENISE SIMONDS
Title or Position: OWNER
Credential: BCBA
Phone: 813-525-5468