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General NPI Number Information
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NPI Number | 1225438336
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Entity Type | Organization
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Legal Business Name | LIFESPAN HEALTH CONSULTANTS
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 13299 HUDSON RD S
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City | AFTON
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State | MN
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Zip | 55001-9303
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Country | US
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Telephone | 651-263-3282
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Fax |
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Provider Business Mailing Address
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Address Line | 13299 HUDSON RD
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City | AFTON
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State | MN
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Zip | 55001
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Country | US
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Telephone | 651-263-3282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KERRY L. WEISS
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Credential | P.T.
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Telephone | 651-263-3282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 4926
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License Number State | MN
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