Provider Demographics
NPI:1285872788
Name:PROGRESSIVE PEDIATRIC THERAPY OF TX, INC.
Entity type:Organization
Organization Name:PROGRESSIVE PEDIATRIC THERAPY OF TX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NENEITTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TABANI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:214-704-9994
Mailing Address - Street 1:2233 DAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2470
Mailing Address - Country:US
Mailing Address - Phone:214-704-9994
Mailing Address - Fax:972-208-4825
Practice Address - Street 1:2233 DAMPTON DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-2470
Practice Address - Country:US
Practice Address - Phone:214-704-9994
Practice Address - Fax:972-208-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110058225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197275401Medicaid