Healthcare Provider Details

I. General information

NPI: 1174943047
Provider Name (Legal Business Name): ABOVE & BEYOND PLAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 NW 1ST AVE
HIGH SPRINGS FL
32643-2653
US

IV. Provider business mailing address

35 NW 1ST AVE
HIGH SPRINGS FL
32643-2653
US

V. Phone/Fax

Practice location:
  • Phone: 352-363-4279
  • Fax: 386-454-1383
Mailing address:
  • Phone: 352-363-4279
  • Fax: 386-454-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT 0001226
License Number StateFL

VIII. Authorized Official

Name: MS. VALERIE GILES EDMANDS
Title or Position: OWNER
Credential: OTR
Phone: 352-256-5581