Healthcare Provider Details

I. General information

NPI: 1043257678
Provider Name (Legal Business Name): PLAY WORKS THERAPIES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 SAN JOSE BLVD SUITE 507
JACKSONVILLE FL
32223-8628
US

IV. Provider business mailing address

12276 SAN JOSE BLVD SUITE 507
JACKSONVILLE FL
32223-8628
US

V. Phone/Fax

Practice location:
  • Phone: 904-288-8910
  • Fax: 904-288-8912
Mailing address:
  • Phone: 904-288-8910
  • Fax: 904-288-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 6455
License Number StateFL

VIII. Authorized Official

Name: JILL MALISZEWSKI
Title or Position: PRESIDENT
Credential: MA CCC/SLP
Phone: 904-288-8910