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General NPI Number Information
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NPI Number | 1225047459
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Entity Type | Organization
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Legal Business Name | LIFESPAN THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 826 CAMINO DEL MONTE REY STE A2
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City | SANTA FE
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State | NM
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Zip | 87505-3961
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Country | US
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Telephone | 505-954-9940
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Fax | 505-954-9946
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Provider Business Mailing Address
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Address Line | 826 CAMINO DEL MONTE REY STE A2
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City | SANTA FE
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State | NM
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Zip | 87505-3961
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Country | US
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Telephone | 505-954-9940
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Fax | 505-954-9946
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DANUSIA KIDANE
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Credential | OTR/L
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Telephone | 505-954-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1011
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2423
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1562
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License Number State | NM
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