MEDICARE: LIFE HEALTH STRENGTH PHYSICAL REHABILITATION 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1770978702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HEALTH STRENGTH PHYSICAL REHABILITATION LLC

Provider Business Mailing Address
First Line	:	PO BOX 12635
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-0035
Country	:	US
Telephone Number	:	267-297-6499
Fax Number	:	267-297-6614

Provider Business Practice Location Address
First Line	:	2000 HAMILTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3814
Country	:	US
Telephone Number	:	267-297-6499
Fax Number	:	267-297-6614

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY/OWNER
Name	:	LATISHA MCKENZIE
Credential	:	DPT
Telephone Number	:	267-297-6499

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	07/20/2020

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