Provider Demographics
NPI:1477168664
Name:GO PLAY THERAPY, LLC
Entity Type:Organization
Organization Name:GO PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEERTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOORAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:405-466-5762
Mailing Address - Street 1:536 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4649
Mailing Address - Country:US
Mailing Address - Phone:405-466-5762
Mailing Address - Fax:
Practice Address - Street 1:536 N 13TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4649
Practice Address - Country:US
Practice Address - Phone:405-466-5762
Practice Address - Fax:844-929-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy