Provider Demographics
NPI:1912063017
Name:SHEPPARD'S PROGRESSIVE REHABILITATION
Entity Type:Organization
Organization Name:SHEPPARD'S PROGRESSIVE REHABILITATION
Other - Org Name:CHILDREN'S ADVANCED THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:678-422-6271
Mailing Address - Street 1:PO BOX 1666
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-1666
Mailing Address - Country:US
Mailing Address - Phone:678-422-6271
Mailing Address - Fax:678-422-6696
Practice Address - Street 1:6505 RIADA CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8535
Practice Address - Country:US
Practice Address - Phone:678-422-6271
Practice Address - Fax:678-422-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002406251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health