Healthcare Provider Details

I. General information

NPI: 1083887004
Provider Name (Legal Business Name): PLAY AND EDUCATION FOR THE DEVELOPMENT OF INFANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15414 N 7TH ST SUITE 3
PHOENIX AZ
85022-3519
US

IV. Provider business mailing address

15414 N 7TH ST SUITE 3
PHOENIX AZ
85022-3519
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-7519
  • Fax:
Mailing address:
  • Phone: 602-476-7519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSLP4319
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5947
License Number StateAZ

VIII. Authorized Official

Name: MRS. LISA JANESE HORN PINSON
Title or Position: OWNER/ PRESIDENT
Credential: PT
Phone: 602-476-7519