Provider Demographics
NPI:1467600965
Name:PROGRESSIVE PEDIATRICS L.L.C.
Entity Type:Organization
Organization Name:PROGRESSIVE PEDIATRICS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEFFANY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:501-258-7944
Mailing Address - Street 1:807 KAMAK DR
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2087
Mailing Address - Country:US
Mailing Address - Phone:501-258-7944
Mailing Address - Fax:
Practice Address - Street 1:27 HIGHWAY 64 W
Practice Address - Street 2:SUITE B
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2094
Practice Address - Country:US
Practice Address - Phone:501-258-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty