Provider Demographics
NPI:1235338757
Name:PROGRESSIVE STEP REHABILITATION
Entity Type:Organization
Organization Name:PROGRESSIVE STEP REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PHYSICAL THERAPIST ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:503-397-2720
Mailing Address - Street 1:75 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 SHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1125
Practice Address - Country:US
Practice Address - Phone:503-397-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTENDICARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7085313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility