NPIMap

Organization Active NPI

Progressive Pediatric Therapy Services Early Intervention

  • Early Intervention Provider Agency
  • Tallahassee, FL
National Provider Identifier
1912459629
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
PROGRESSIVE PEDIATRIC THERAPY SERVICES EARLY INTERVENTION
Practice address
1725 Hermitage Blvd
Tallahassee, FL 32308-7709
Phone
(850) 325-6301
Fax
(850) 325-6302
NPI assigned
Oct 28, 2016
Last updated
Dec 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly Quin Prejean, MA, CCC-SLPNPI 1477502011
Title
Clinic Director
Phone
(850) 325-6301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X NU Primary

Addresses

Primary practice location

1725 Hermitage Blvd
Tallahassee, FL 32308-7709

Mailing address

1725 Hermitage Blvd
Tallahassee, FL 32308-7709
Phone (850) 325-6301

Other identifiers 1

IdentifierTypeStateIssuer
003247800MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Impact Therapy LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1912459629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 HERMITAGE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087709",
            "telephone_number": "850-325-6301",
            "fax_number": "850-325-6302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 HERMITAGE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087709",
            "telephone_number": "850-325-6301",
            "fax_number": "850-325-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE PEDIATRIC THERAPY SERVICES EARLY INTERVENTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "PREJEAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "QUIN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "850-325-6301",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003247800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.