Healthcare Provider Details

I. General information

NPI: 1730903840
Provider Name (Legal Business Name): LIFE BEYOND LIMITS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 NE 10TH TER
CAPE CORAL FL
33909-1431
US

IV. Provider business mailing address

904 NE 10TH TER
CAPE CORAL FL
33909-1431
US

V. Phone/Fax

Practice location:
  • Phone: 239-265-2951
  • Fax:
Mailing address:
  • Phone: 239-265-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARLEY FERNANDEZ
Title or Position: CEO
Credential: MS, OTR/L
Phone: 239-265-2951