Healthcare Provider Details

I. General information

NPI: 1366221038
Provider Name (Legal Business Name): PLAYFUL PROGRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 11/25/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 NE CHARDON ST
JENSEN BEACH FL
34957-4004
US

IV. Provider business mailing address

1423 NE CHARDON ST
JENSEN BEACH FL
34957-4004
US

V. Phone/Fax

Practice location:
  • Phone: 772-342-5596
  • Fax:
Mailing address:
  • Phone: 772-342-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK JOY
Title or Position: RA / OWNER
Credential: PTA
Phone: 772-342-5596