Provider Demographics
NPI:1679155295
Name:FUNCTIONAL PLAYGROUND THERAPIES LLC
Entity Type:Organization
Organization Name:FUNCTIONAL PLAYGROUND THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:505-263-0583
Mailing Address - Street 1:8205 PORTALES ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4955
Mailing Address - Country:US
Mailing Address - Phone:505-263-0583
Mailing Address - Fax:
Practice Address - Street 1:9577 OSUNA RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2286
Practice Address - Country:US
Practice Address - Phone:505-263-0583
Practice Address - Fax:505-317-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty