Provider Demographics
NPI:1538484605
Name:PROGRESSIVE REHAB SOLUTIONS
Entity Type:Organization
Organization Name:PROGRESSIVE REHAB SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:314-831-6375
Mailing Address - Street 1:100 SAINT FRANCOIS ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5131
Mailing Address - Country:US
Mailing Address - Phone:314-839-1623
Mailing Address - Fax:314-473-1019
Practice Address - Street 1:100 SAINT FRANCOIS ST STE 110
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5131
Practice Address - Country:US
Practice Address - Phone:314-839-1623
Practice Address - Fax:314-473-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005026624251E00000X, 252Y00000X, 261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1936Medicare PIN