Provider Demographics
NPI:1053719526
Name:CHILD'S PLAY THERAPY, LLC
Entity type:Organization
Organization Name:CHILD'S PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRENCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:660-525-6267
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-0142
Mailing Address - Country:US
Mailing Address - Phone:660-525-6267
Mailing Address - Fax:
Practice Address - Street 1:148 NW 1150TH RD
Practice Address - Street 2:
Practice Address - City:CHILHOWEE
Practice Address - State:MO
Practice Address - Zip Code:64733-8107
Practice Address - Country:US
Practice Address - Phone:660-525-6267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0850303261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy