Healthcare Provider Details

I. General information

NPI: 1225704802
Provider Name (Legal Business Name): THERAPLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 TIFT AVE N STE B
TIFTON GA
31794-3577
US

IV. Provider business mailing address

96232 RIDGEWOOD CIR
FERNANDINA BEACH FL
32034-8160
US

V. Phone/Fax

Practice location:
  • Phone: 229-396-5644
  • Fax: 855-565-1769
Mailing address:
  • Phone: 678-761-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY JAMES RUTLAND II
Title or Position: OWNER
Credential: OTR/L
Phone: 678-761-2863