MEDICARE: PROGRESSIVE THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22002982	IN

General Provider Information

NPI Number	:	1336272418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE THERAPY SERVICES

Provider Business Mailing Address
First Line	:	3647 BRANCH WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3678
Country	:	US
Telephone Number	:	317-989-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	3647 BRANCH WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3678
Country	:	US
Telephone Number	:	317-989-2229
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. YVETTE RENEE WHITE
Credential	:	MS,CCC-SLP
Telephone Number	:	317-989-2229

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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Directions to “PROGRESSIVE THERAPY SERVICES ” Practice Location

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