Provider Demographics
NPI:1598708109
Name:THERAPLAY LLC
Entity Type:Organization
Organization Name:THERAPLAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FACTORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-332-7529
Mailing Address - Street 1:4651 W VERNAL PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9334
Mailing Address - Country:US
Mailing Address - Phone:812-332-7529
Mailing Address - Fax:812-339-7529
Practice Address - Street 1:4651 W VERNAL PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9334
Practice Address - Country:US
Practice Address - Phone:812-332-7529
Practice Address - Fax:812-339-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004408A225100000X
IN31003809A225X00000X
IN22002743A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200265520AMedicaid
IN200265520AMedicaid
IN250350Medicare PIN
IN250350AMedicare PIN