Provider Demographics
NPI:1255613303
Name:THERAPLAY PEDIATRIC SERVICES, INC.
Entity type:Organization
Organization Name:THERAPLAY PEDIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:404-314-5505
Mailing Address - Street 1:2150 LA DAWN LN NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1930
Mailing Address - Country:US
Mailing Address - Phone:404-314-5505
Mailing Address - Fax:404-355-6814
Practice Address - Street 1:80 W WIEUCA RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3205
Practice Address - Country:US
Practice Address - Phone:404-314-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency