Healthcare Provider Details

I. General information

NPI: 1528552007
Provider Name (Legal Business Name): THERAPY PLAYGROUND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SLEEPY DR STE GHI
SPRING LAKE NC
28390-3324
US

IV. Provider business mailing address

4602 CUMBERLAND RD
FAYETTEVILLE NC
28306-2412
US

V. Phone/Fax

Practice location:
  • Phone: 910-423-5622
  • Fax: 910-378-1755
Mailing address:
  • Phone: 910-423-5622
  • Fax: 910-378-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier146
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: JENNIFER L ROSENTHAL-DIBB
Title or Position: PRESIDENT
Credential: MC CCC-SLP
Phone: 910-423-5622