Provider Demographics
NPI:1841311438
Name:PROGRESSIVE THERAPISTS, INC.
Entity type:Organization
Organization Name:PROGRESSIVE THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPISTS
Authorized Official - Prefix:MISS
Authorized Official - First Name:GAISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:219-887-0475
Mailing Address - Street 1:4032 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-2552
Mailing Address - Country:US
Mailing Address - Phone:219-887-0475
Mailing Address - Fax:219-980-0467
Practice Address - Street 1:4032 TYLER ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-2552
Practice Address - Country:US
Practice Address - Phone:219-887-0475
Practice Address - Fax:219-980-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN949583222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty