Provider Demographics
NPI:1750018511
Name:PROGRESSIVE PLAY THERAPY LLC
Entity type:Organization
Organization Name:PROGRESSIVE PLAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-329-0185
Mailing Address - Street 1:3 RED HILL LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 RED HILL LN
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6187
Practice Address - Country:US
Practice Address - Phone:630-329-0185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty