Healthcare Provider Details

I. General information

NPI: 1982779906
Provider Name (Legal Business Name): EDUCATED PLAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8673 15TH WAY N
ST PETERSBURG FL
33702-2815
US

IV. Provider business mailing address

8673 15TH WAY N
ST PETERSBURG FL
33702-2815
US

V. Phone/Fax

Practice location:
  • Phone: 727-423-0060
  • Fax: 727-369-8803
Mailing address:
  • Phone: 727-423-0060
  • Fax: 727-369-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 13130
License Number StateFL

VIII. Authorized Official

Name: LAURI B LEE
Title or Position: OWNER, PRESIDENT
Credential: M.S., P.T.
Phone: 727-423-0060