Provider Demographics
NPI:1366221038
Name:PLAYFUL PROGRESS LLC
Entity type:Organization
Organization Name:PLAYFUL PROGRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RA / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:772-342-5596
Mailing Address - Street 1:1423 NE CHARDON ST
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4004
Mailing Address - Country:US
Mailing Address - Phone:772-342-5596
Mailing Address - Fax:
Practice Address - Street 1:1423 NE CHARDON ST
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4004
Practice Address - Country:US
Practice Address - Phone:772-342-5596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty