Provider Demographics
NPI:1912322215
Name:PLAYBIG THERAPY & RECREATION ZONE, LLC
Entity Type:Organization
Organization Name:PLAYBIG THERAPY & RECREATION ZONE, LLC
Other - Org Name:PLAYBIG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:HACKLER
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-942-2000
Mailing Address - Street 1:4500 W SHANNON LAKES DR STE 3
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2240
Mailing Address - Country:US
Mailing Address - Phone:850-942-2000
Mailing Address - Fax:850-942-2003
Practice Address - Street 1:4500 W SHANNON LAKES DR STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2240
Practice Address - Country:US
Practice Address - Phone:850-942-2000
Practice Address - Fax:850-942-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-23
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010690100Medicaid
FL013602400Medicaid
FL013441900Medicaid
FL887243100Medicaid