Healthcare Provider Details

I. General information

NPI: 1215252390
Provider Name (Legal Business Name): LIFE-SPAN NEURO-DEVELOPMENTAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E SANDUSKY ST SUITE 3
FINDLAY OH
45840-6463
US

IV. Provider business mailing address

1700 E SANDUSKY ST SUITE 3
FINDLAY OH
45840-6463
US

V. Phone/Fax

Practice location:
  • Phone: 419-422-6387
  • Fax: 419-425-7055
Mailing address:
  • Phone: 419-424-6387
  • Fax: 419-425-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateOH

VIII. Authorized Official

Name: BETH MUNOZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 419-422-6387