Provider Demographics
NPI:1740043868
Name:PLAYFUL PEDS THERAPY LLC
Entity type:Organization
Organization Name:PLAYFUL PEDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREBOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:561-884-0885
Mailing Address - Street 1:9 INLET CAY DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5206
Mailing Address - Country:US
Mailing Address - Phone:561-884-0885
Mailing Address - Fax:
Practice Address - Street 1:9 INLET CAY DR
Practice Address - Street 2:
Practice Address - City:OCEAN RIDGE
Practice Address - State:FL
Practice Address - Zip Code:33435-5206
Practice Address - Country:US
Practice Address - Phone:561-884-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1144836719Medicaid