Healthcare Provider Details

I. General information

NPI: 1417603564
Provider Name (Legal Business Name): PROGRESS PATH ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 77TH CT E
PALMETTO FL
34221-2588
US

IV. Provider business mailing address

3311 77TH CT E
PALMETTO FL
34221-2588
US

V. Phone/Fax

Practice location:
  • Phone: 813-514-5341
  • Fax:
Mailing address:
  • Phone: 813-514-5341
  • 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 Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SHAYLA RENEE ELLIS
Title or Position: OWNER
Credential: BCBA
Phone: 813-514-5341