Organization
INTENTIONAL PLAY, INC
Active
Other names
Intentional Play Pediatric Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
KRISITN IBACH OWEN PT (PRESIDENT)
(904) 434-5673
Entity
Organization
Contact information
Practice address
4712 MARSH HAMMOCK DR W, JACKSONVILLE, FL 32224-1858
(904) 434-5673
Mailing address
4712 MARSH HAMMOCK DR W, JACKSONVILLE, FL 32224-1858
(904) 434-5673
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT6722
FL
Other
Enumeration date
12/26/2016
Last updated
12/29/2016
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