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General NPI Number Information
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NPI Number | 1275559759
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC LIFE CENTER, INC.
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 102 EASTBROOK DR SUITE C
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City | GREENVILLE
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State | NC
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Zip | 27858-4320
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Country | US
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Telephone | 252-830-0245
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Fax | 252-830-0247
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Provider Business Mailing Address
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Address Line | 102 EASTBROOK DRIVE B AND C
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City | GREENVILLE
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State | NC
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Zip | 27858-4320
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Country | US
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Telephone | 252-830-0245
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Fax | 252-830-0247
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | JEANNE C ROSAL
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Credential | OTR/L
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Telephone | 252-830-0245
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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 |
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License Number State |
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Taxonomy #2
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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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