NPIMap

Organization Active NPI

Theraplay LLC

  • Pediatrics Physician
  • Tifton, GA
National Provider Identifier
1225704802
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
THERAPLAY LLC
Practice address
1401 Tift Ave N Ste B
Tifton, GA 31794-3577
Phone
(229) 396-5644
Fax
(855) 565-1769
NPI assigned
Aug 23, 2021
Last updated
Oct 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Mr. Larry James Rutland II, OTR/LNPI 1356908420
Title
Owner
Phone
(678) 761-2863

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Pediatric Occupational Therapist 225XP0200X NU
Hearing and Speech Clinic/Center 261QH0700X NU
Physical Therapy Clinic/Center 261QP2000X NU

Addresses

Primary practice location

1401 Tift Ave N Ste B
Tifton, GA 31794-3577

Mailing address

96232 Ridgewood Cir
Fernandina Beach, FL 32034-8160
Phone (678) 761-2863

Other identifiers 1

IdentifierTypeStateIssuer
003261217AMedicaidGA

National Provider Directory

National Provider Directory

Locations

22391 Flora Parke Xing
Unit A
Fernandina Beach, FL 32034
Phone (904) 321-9054

103 City Smitty Dr
Saint Marys, GA 31558

1878 US Highway 82 W
Tifton, GA 31793

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1225704802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96232 RIDGEWOOD CIR",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320348160",
            "telephone_number": "678-761-2863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 TIFT AVE N STE B",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943577",
            "telephone_number": "229-396-5644",
            "fax_number": "855-565-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPLAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "RUTLAND",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-761-2863",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003261217A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.