Healthcare Provider Details

I. General information

NPI: 1295480929
Provider Name (Legal Business Name): PLAY TIME PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 COUNTRY CLUB BLVD
CHESAPEAKE VA
23322-2137
US

IV. Provider business mailing address

129 COUNTRY CLUB BLVD
CHESAPEAKE VA
23322-2137
US

V. Phone/Fax

Practice location:
  • Phone: 757-580-0766
  • Fax:
Mailing address:
  • Phone: 757-580-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA C ROSE
Title or Position: OWNER OF PLAY TIME PHYSICAL THERAPY
Credential: PT, DPT, C/NDT
Phone: 757-580-0766