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General NPI Number Information
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NPI Number | 1215496450
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Entity Type | Organization
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Legal Business Name | LIFETIME BODY AND HEALTH AWARENESS PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 1489 W WARM SPRINGS RD STE 110
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City | HENDERSON
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State | NV
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Zip | 89014-7367
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Country | US
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Telephone | 725-286-7997
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Fax | 888-414-7996
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Provider Business Mailing Address
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Address Line | 1489 W WARM SPRINGS RD STE 110
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City | HENDERSON
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State | NV
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Zip | 89014-7367
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Country | US
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Telephone | 725-286-7997
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Fax | 888-414-7996
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | SHENITA HAYNES
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Credential | DPT,CEEAA
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Telephone | 702-831-8076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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