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NPI Code Detail

MEDICARE: GO PLAY THERAPY CENTER, LLC

MEDICARE: GO PLAY THERAPY CENTER, LLC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1962890376
Entity Type Code : Organization
Provider Name (Legal Business Name) : GO PLAY THERAPY CENTER, LLC
Provider Business Mailing Address
First Line : 66 COUNTY ROAD 100
Second Line :
City : FYFFE
State : AL
Zip : 35971-5161
Country : US
Telephone Number : 265-979-1222
Fax Number : 256-979-1223
Provider Business Practice Location Address
First Line : 2804 GREENHILL BLVD NW
Second Line :
City : FORT PAYNE
State : AL
Zip : 35968-3066
Country : US
Telephone Number : 256-979-1222
Fax Number : 256-979-1223
Authorized Official
Title or Position : OWNER/ MANAGER
Name : SILVIA HERNANDEZ
Credential :
Telephone Number : 256-979-1222
Provider Enumeration Date : 01/07/2015
Last Update Date : 01/07/2015

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Directions to “GO PLAY THERAPY CENTER, LLC ” Practice Location

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