Provider Demographics
NPI:1144593047
Name:PROGRESS VILLAGE PEDIATRIC THERAPY SERVICES
Entity Type:Organization
Organization Name:PROGRESS VILLAGE PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:404-932-3440
Mailing Address - Street 1:2949 STONECREST PT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4955
Mailing Address - Country:US
Mailing Address - Phone:404-932-3440
Mailing Address - Fax:770-483-3955
Practice Address - Street 1:2949 SONECREST PT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4955
Practice Address - Country:US
Practice Address - Phone:404-932-3440
Practice Address - Fax:770-483-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty