MEDICARE: PEDIATRIC THERAPY PLAYHOUSE

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	SP21339	CA

General Provider Information

NPI Number	:	1790181691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPY PLAYHOUSE

Provider Business Mailing Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-571-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-571-5726
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA GINSBURG
Credential	:
Telephone Number	:	310-571-5726

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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Directions to “PEDIATRIC THERAPY PLAYHOUSE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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