Provider Demographics
NPI:1588350524
Name:PLAY TO LEARN THERAPY, LLC.
Entity type:Organization
Organization Name:PLAY TO LEARN THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-824-4735
Mailing Address - Street 1:8217 SW 72ND AVE APT 1212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7992
Mailing Address - Country:US
Mailing Address - Phone:786-824-4735
Mailing Address - Fax:
Practice Address - Street 1:8217 SW 72ND AVE APT 1212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7992
Practice Address - Country:US
Practice Address - Phone:786-824-4735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020734700Medicaid
FL110524400Medicaid