Provider Demographics
NPI:1467956557
Name:PLAYWORKS PEDIATRIC THERAPY AND PLAY GYM, LLC
Entity Type:Organization
Organization Name:PLAYWORKS PEDIATRIC THERAPY AND PLAY GYM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-267-2777
Mailing Address - Street 1:128 SOUTHWINDS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8652
Mailing Address - Country:US
Mailing Address - Phone:479-267-2777
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTHWINDS RD STE 7
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8652
Practice Address - Country:US
Practice Address - Phone:479-267-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2778225100000X
OTR2016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163187721Medicaid
AR157390721Medicaid