Provider Demographics
NPI:1679697569
Name:MIND, BODY & PLAY THERAPIES, LLC
Entity Type:Organization
Organization Name:MIND, BODY & PLAY THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-981-4470
Mailing Address - Street 1:466 BLACK FEATHER LOOP
Mailing Address - Street 2:#520
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8008
Mailing Address - Country:US
Mailing Address - Phone:303-981-4470
Mailing Address - Fax:303-223-7608
Practice Address - Street 1:466 BLACK FEATHER LOOP
Practice Address - Street 2:#520
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-8008
Practice Address - Country:US
Practice Address - Phone:303-981-4470
Practice Address - Fax:303-223-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 64272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12456535Medicaid