MEDICARE: LIFELINE THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1154318509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE THERAPY, LLC

Provider Business Mailing Address
First Line	:	100 FOREST HILLS PLZ
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15221-5211
Country	:	US
Telephone Number	:	412-829-2450
Fax Number	:	412-829-2468

Provider Business Practice Location Address
First Line	:	4000 WATERDAM PLAZA DRIVE
Second Line	:	SUITE 260
City	:	MCMURRAY
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-941-5340
Fax Number	:	724-941-5341

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. CHRIS J BREHM
Credential	:
Telephone Number	:	412-829-2450

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/17/2012

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