Intentional Play, Inc

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT6722 Issued in FL

Legal business name

INTENTIONAL PLAY, INC

Doing business as

Intentional Play Pediatric Therapy Services

Practice address

4712 Marsh Hammock Dr W
Jacksonville, FL 32224-1858

Phone

(904) 434-5673

NPI assigned

Dec 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Krisitn Ibach Owen, PT

Title

President

Phone

(904) 434-5673

Specialties & licenses 1

Addresses

Other names 1

• Intentional Play Pediatric Therapy Services Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482969600000",
    "number": "1063957298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 MARSH HAMMOCK DR W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241858",
            "telephone_number": "904-434-5673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 MARSH HAMMOCK DR W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241858",
            "telephone_number": "904-434-5673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL PLAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-26",
        "last_updated": "2016-12-29",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "KRISITN",
        "authorized_official_middle_name": "IBACH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-434-5673",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT6722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intentional Play Pediatric Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Physical Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.