Basic Information
| Provider Information | |||||||||
| NPI: | 1295340776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLAYGROUND CHILDREN'S THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 SMITHVILLE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783332333 | ||||||||
| FaxNumber: | 4782854256 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 SMITHVILLE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783332333 | ||||||||
| FaxNumber: | 4782854256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2020 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | KNIGHT | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4783332333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.