MEDICARE: LIFETIME 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	235Z00000X	Speech-Language Pathologist	2202005537	VA

General Provider Information

NPI Number	:	1710324215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME THERAPY, LLC

Provider Business Mailing Address
First Line	:	14573 POTOMAC MILLS RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-6808
Country	:	US
Telephone Number	:	703-203-7468
Fax Number	:

Provider Business Practice Location Address
First Line	:	14573 POTOMAC MILLS RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-6808
Country	:	US
Telephone Number	:	703-203-7468
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	LIANA RENEE TOYER
Credential	:	M.A. CC-SLP
Telephone Number	:	703-507-5525

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	08/19/2013

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Directions to “LIFETIME THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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