Healthcare Provider Details

I. General information

NPI: 1457296394
Provider Name (Legal Business Name): PROGRESS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S WOODRUFF AVE STE B7
IDAHO FALLS ID
83401-4866
US

IV. Provider business mailing address

211 S WOODRUFF AVE STE B7
IDAHO FALLS ID
83401-4866
US

V. Phone/Fax

Practice location:
  • Phone: 208-907-7306
  • Fax:
Mailing address:
  • Phone: 208-502-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LARISSA BROWNE
Title or Position: OWNER
Credential: LCSW
Phone: 208-502-2805