Provider Demographics
NPI:1336583392
Name:PROGRESSIVE PEDIATRIC THERAPY, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUECK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:561-376-2573
Mailing Address - Street 1:PO BOX 273253
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33427-3253
Mailing Address - Country:US
Mailing Address - Phone:561-376-2573
Mailing Address - Fax:561-218-4939
Practice Address - Street 1:5589 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4486
Practice Address - Country:US
Practice Address - Phone:561-376-2573
Practice Address - Fax:561-218-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT195952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty