Healthcare Provider Details

I. General information

NPI: 1952013450
Provider Name (Legal Business Name): PLAY WITH PURPOSE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POINTE NORTH DR STE 109
CARTERSVILLE GA
30120-7955
US

IV. Provider business mailing address

1267 OAK GROVE RD SW
CALHOUN GA
30701-3251
US

V. Phone/Fax

Practice location:
  • Phone: 770-324-8560
  • Fax:
Mailing address:
  • Phone: 770-324-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
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: CRYSTAL SUMNER
Title or Position: PT/OWNER
Credential: PT
Phone: 770-324-8560