Healthcare Provider Details

I. General information

NPI: 1578884490
Provider Name (Legal Business Name): LIFESPAN REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5083 4TH LN
VERO BEACH FL
32968-1865
US

IV. Provider business mailing address

5083 4TH LN
VERO BEACH FL
32968-1865
US

V. Phone/Fax

Practice location:
  • Phone: 772-643-2939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY RICHARDS JR.
Title or Position: MANAGER/OCCUPATIONAL THERAPIST
Credential:
Phone: 772-643-2939