Provider Demographics
NPI:1770554990
Name:THERAPLAY, INC.
Entity type:Organization
Organization Name:THERAPLAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRON
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:479-856-6571
Mailing Address - Street 1:505 E DOUBLE EAGLE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7143
Mailing Address - Country:US
Mailing Address - Phone:479-856-6571
Mailing Address - Fax:479-856-6571
Practice Address - Street 1:505 E DOUBLE EAGLE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-7143
Practice Address - Country:US
Practice Address - Phone:479-856-6571
Practice Address - Fax:479-856-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158131716Medicaid
AR139854742Medicaid