Provider Demographics
NPI:1194028654
Name:PROPLAY PEDIATRIC PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PROPLAY PEDIATRIC PHYSICAL THERAPY, INC.
Other - Org Name:PROPLAY REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-899-7653
Mailing Address - Street 1:2100 VALLEY VIEW PKWY., # 1332
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-837-0561
Mailing Address - Fax:
Practice Address - Street 1:2100 VALLEY VIEW PKWY
Practice Address - Street 2:SUITE 1332
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5536
Practice Address - Country:US
Practice Address - Phone:916-899-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24980225100000X
CA15318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty