MEDICARE: EAT PLAY LOVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1023884285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAT PLAY LOVE

Provider Business Mailing Address
First Line	:	24165 MINNETONKA LN
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1914
Country	:	US
Telephone Number	:	949-701-1896
Fax Number	:

Provider Business Practice Location Address
First Line	:	24165 MINNETONKA LN
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1914
Country	:	US
Telephone Number	:	949-701-1896
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	BRITTANY GLASS
Credential	:	OTR/L, SWC, CLC
Telephone Number	:	949-701-1896

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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Directions to “EAT PLAY LOVE ” Practice Location

Language	Start Address	Practice Location

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