Provider Demographics
NPI:1710051560
Name:PROGRESSIVE PEDIATRIC THERAPY INC.
Entity Type:Organization
Organization Name:PROGRESSIVE PEDIATRIC THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:574-340-3567
Mailing Address - Street 1:3910 HARRISON CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9159
Mailing Address - Country:US
Mailing Address - Phone:574-254-0028
Mailing Address - Fax:574-254-0039
Practice Address - Street 1:3910 HARRISON CREEK CT
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9159
Practice Address - Country:US
Practice Address - Phone:574-254-0028
Practice Address - Fax:574-254-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002749A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty