Provider Demographics
NPI:1083805576
Name:SHEPHERD IMPACT SERVICES INC.
Entity Type:Organization
Organization Name:SHEPHERD IMPACT SERVICES INC.
Other - Org Name:PROGRESSIVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-734-3362
Mailing Address - Street 1:2415 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6801
Mailing Address - Country:US
Mailing Address - Phone:214-734-3362
Mailing Address - Fax:972-206-2569
Practice Address - Street 1:2415 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6801
Practice Address - Country:US
Practice Address - Phone:214-734-3362
Practice Address - Fax:972-206-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health