Provider Demographics
NPI:1164555173
Name:PROGRESSIVE STEP CORP
Entity Type:Organization
Organization Name:PROGRESSIVE STEP CORP
Other - Org Name:PROGRESSIVE STEP REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-8119
Mailing Address - Street 1:111 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2903
Mailing Address - Country:US
Mailing Address - Phone:414-908-8119
Mailing Address - Fax:414-908-7105
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:SUITE 65
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2105
Practice Address - Country:US
Practice Address - Phone:806-468-7611
Practice Address - Fax:806-468-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21726701Medicaid
456806Medicare Oscar/Certification