Healthcare Provider Details

I. General information

NPI: 1306740139
Provider Name (Legal Business Name): PLAY-ON THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22952 E IVANHOE ST
MESA AZ
85212-8897
US

IV. Provider business mailing address

22952 E IVANHOE ST
MESA AZ
85212-8897
US

V. Phone/Fax

Practice location:
  • Phone: 480-252-4651
  • Fax:
Mailing address:
  • Phone: 480-252-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHANNON LYNN BISHOP
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 480-252-4651