| Organization Name: | PLAY MOVE GROW PEDIATRIC THERAPY, LLC |
| NPI Number: | 1073981247 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANETTE K VAN DUYNE (MANAGER) |
| Mailing Address: | 2539 Norma St Titusville |
| State: | FL US |
| Postal Code: | 327802845 |
| Phone Number: | 3214460064 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2015 |
| NPI Last Update Date: | 09/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | PT 18971 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |