MEDICARE: RETAP LIFE PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346831211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETAP LIFE PLLC

Provider Business Mailing Address
First Line	:	6831 N 17TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2738
Country	:	US
Telephone Number	:	484-393-5257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6831 N 17TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2738
Country	:	US
Telephone Number	:	484-393-5257
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERRINA BROOKS
Credential	:	PH.D.
Telephone Number	:	484-393-5257

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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