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General NPI Number Information
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NPI Number | 1568654739
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Entity Type | Organization
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Legal Business Name | NEW LIFE THERAPY GROUP, INC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 968 TROON TRCE
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-4318
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Country | US
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Telephone | 407-619-5427
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Fax | 321-348-3604
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Provider Business Mailing Address
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Address Line | 5703 RED BUG LAKE RD # 177
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-4969
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Country | US
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Telephone | 407-619-5427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL DIRECTOR
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Name | MRS. TINA CRUZ
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Credential | MS
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Telephone | 407-619-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA9162
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License Number State | FL
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