Provider Demographics
NPI:1194034066
Name:LIFE BALANCE REHABILITATION
Entity Type:Organization
Organization Name:LIFE BALANCE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MORROW
Authorized Official - Last Name:SHIFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTRL, BCPR
Authorized Official - Phone:804-330-4527
Mailing Address - Street 1:11911 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6103
Mailing Address - Country:US
Mailing Address - Phone:804-330-4527
Mailing Address - Fax:
Practice Address - Street 1:11911 SPRING CREEK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6103
Practice Address - Country:US
Practice Address - Phone:804-330-4527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000462225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty