MEDICARE: PLAYFUL PATHS PEDIATRIC THERAPY

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1043141070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAYFUL PATHS PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	447 PUMA LOOP
Second Line	:
City	:	GROVELAND
State	:	FL
Zip	:	34736-3507
Country	:	US
Telephone Number	:	561-460-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 S DILLARD ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3559
Country	:	US
Telephone Number	:	561-460-6113
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUMMER SQUILLACIOTI
Credential	:	OTD
Telephone Number	:	561-460-6113

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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