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General NPI Number Information
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NPI Number | 1932752730
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Entity Type | Organization
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Legal Business Name | HORSEPLAY THERAPY CENTER
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Dates
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Enumeration Date | 07/20/2019
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Last Update Date | 07/20/2019
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Provider Practice Location Address
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Address Line | 1925 STATE ROAD 207
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-9325
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Country | US
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Telephone | 904-315-8525
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Fax | 904-794-6917
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Provider Business Mailing Address
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Address Line | 3533 CAROLWOOD LN
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-4320
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Country | US
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Telephone | 904-315-8525
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VICKY CARREGAL
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Credential |
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Telephone | 904-315-8525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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