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General NPI Number Information
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NPI Number | 1578884490
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Entity Type | Organization
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Legal Business Name | LIFESPAN REHABILITATION, LLC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 5083 4TH LN
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City | VERO BEACH
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State | FL
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Zip | 32968-1865
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Country | US
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Telephone | 772-643-2939
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Fax |
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Provider Business Mailing Address
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Address Line | 5083 4TH LN
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City | VERO BEACH
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State | FL
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Zip | 32968-1865
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER/OCCUPATIONAL THERAPIST
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Name | TIMOTHY RICHARDS JR.
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Credential |
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Telephone | 772-643-2939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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