Provider Demographics
NPI:1508921065
Name:CHILD'S PLAY PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:CHILD'S PLAY PEDIATRIC THERAPY, LLC
Other - Org Name:THE CENTER FOR PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:985-228-0726
Mailing Address - Street 1:819 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3783
Mailing Address - Country:US
Mailing Address - Phone:985-228-0726
Mailing Address - Fax:985-449-0945
Practice Address - Street 1:1713 RIDGEFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4399
Practice Address - Country:US
Practice Address - Phone:985-228-0726
Practice Address - Fax:985-449-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA040812251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty