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NPI Code Detail

MEDICARE: PROGRESSIVE THEARPY SERVICES

MEDICARE: PROGRESSIVE THEARPY 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
1235Z00000XSpeech-Language Pathologist
2225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1457778946
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE THEARPY SERVICES
Provider Business Mailing Address
First Line : 220 W BRANDON BLVD
Second Line : SUITE 210
City : BRANDON
State : FL
Zip : 33511-5104
Country : US
Telephone Number : 813-525-5468
Fax Number : 813-438-8903
Provider Business Practice Location Address
First Line : 220 W BRANDON BLVD
Second Line : SUITE 210
City : BRANDON
State : FL
Zip : 33511-5104
Country : US
Telephone Number : 813-525-5468
Fax Number : 813-438-8903
Authorized Official
Title or Position : OWNER
Name : MS. STACEY DENISE SIMONDS
Credential : BCBA
Telephone Number : 813-525-5468
Provider Enumeration Date : 03/24/2014
Last Update Date : 03/24/2014

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Directions to “PROGRESSIVE THEARPY SERVICES ” Practice Location

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