Healthcare Provider Details

I. General information

NPI: 1770974586
Provider Name (Legal Business Name): PLAY-BASED PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 07/21/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E CAPITOL ST SE
WASHINGTON DC
20003-3903
US

IV. Provider business mailing address

913 E CAPITOL ST SE
WASHINGTON DC
20003-3903
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-7529
  • Fax: 202-544-2060
Mailing address:
  • Phone: 202-546-7529
  • Fax: 202-544-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT870072
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA P SMITH
Title or Position: CEO
Credential: PT
Phone: 202-546-7529