Healthcare Provider Details

I. General information

NPI: 1972964708
Provider Name (Legal Business Name): LIFEWORKS UNILIMITED PEDIATRIC THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FLAMELEAF CT
LEWISVILLE NC
27023-8611
US

IV. Provider business mailing address

1009 FLAMELEAF CT
LEWISVILLE NC
27023-8611
US

V. Phone/Fax

Practice location:
  • Phone: 336-946-6313
  • Fax: 336-776-0099
Mailing address:
  • Phone: 336-946-6313
  • Fax: 336-776-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number9318
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberP15179
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5565
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6431
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6431
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number6431
License Number StateNC

VIII. Authorized Official

Name: MS. MARIE ADELFA NUNEZ
Title or Position: OWNER
Credential: COTA/L
Phone: 786-217-7544