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General NPI Number Information
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NPI Number | 1225045362
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Entity Type | Organization
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Legal Business Name | LIFETRACK RESOURCES, INC.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 709 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-4804
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Country | US
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Telephone | 651-227-8471
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Fax | 651-265-2318
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Provider Business Mailing Address
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Address Line | 709 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-4804
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Country | US
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Telephone | 651-227-8471
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Fax | 651-265-2318
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRIXIE ANN GOLBERG
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Credential |
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Telephone | 651-227-8471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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