Provider Demographics
NPI:1740505585
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: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 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
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:2010-04-05
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty