=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487796454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE JUNGLE GYM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 SHINNECOCK ROAD
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-734-1515
-----------------------------------------------------
Fax | 302-734-1591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 SHINNECOCK ROAD
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-734-1515
-----------------------------------------------------
Fax | 302-734-1591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. TRACEY D GOFF
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 302-734-1515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 2005212081
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 2005212081
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2005212081
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------