MEDICARE: THERAPY PLAYGROUND, INC

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	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013PW	OTHER	NC	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467433680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY PLAYGROUND, INC

Provider Business Mailing Address
First Line	:	4602 CUMBERLAND RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2412
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-378-1755

Provider Business Practice Location Address
First Line	:	4602 CUMBERLAND RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2412
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-378-1755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JENNIFER L ROSENTHAL-DIBB
Credential	:	MS CCC-SLP
Telephone Number	:	910-423-5622

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	03/15/2021

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Directions to “THERAPY PLAYGROUND, INC ” Practice Location

Language	Start Address	Practice Location

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