Provider Demographics
NPI:1063669109
Name:PROGRESSIVE NEURO THERAPY PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE NEURO THERAPY PLLC
Other - Org Name:PROGRESSIVE NEURO THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:512-200-2332
Mailing Address - Street 1:5555 N LAMAR BLVD
Mailing Address - Street 2:STE L 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1073
Mailing Address - Country:US
Mailing Address - Phone:512-200-2332
Mailing Address - Fax:512-852-4557
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:STE L 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-200-2332
Practice Address - Fax:512-852-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251N0400X, 235Z00000X
TX106204225XN1300X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty