=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710717087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREE OF LIFE PT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2024
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6050 ROBERTA RD
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28075-8578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-241-1014
-----------------------------------------------------
Fax | 980-258-8338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6050 ROBERTA RD
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28075-8578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-241-1014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/OWNER
-----------------------------------------------------
Name | DANIELA BEAUVAIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-241-1014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------