Provider Demographics
NPI:1750550604
Name:UNIVERSAL PROGRESSIVE THERAPY, INC.
Entity type:Organization
Organization Name:UNIVERSAL PROGRESSIVE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VARLEISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:973-800-6291
Mailing Address - Street 1:242 WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3934
Mailing Address - Country:US
Mailing Address - Phone:973-800-6291
Mailing Address - Fax:877-591-5378
Practice Address - Street 1:242 WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3934
Practice Address - Country:US
Practice Address - Phone:973-800-6291
Practice Address - Fax:877-591-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00328300231H00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty