Healthcare Provider Details

I. General information

NPI: 1609909621
Provider Name (Legal Business Name): PROGRESSIVE STEP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W UNION ST
ATHENS OH
45701-2334
US

IV. Provider business mailing address

111 W MICHIGAN ST
MILWAUKEE WI
53203-2903
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-8787
  • Fax: 740-592-5989
Mailing address:
  • Phone: 414-908-8119
  • Fax: 414-908-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA J MAASSEN
Title or Position: PRIVACY OFFICER
Credential:
Phone: 414-908-8119