Provider Demographics
NPI:1225465818
Name:NEW LIFE PHYSICAL & MASSAGE THERAPY
Entity Type:Organization
Organization Name:NEW LIFE PHYSICAL & MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-679-0133
Mailing Address - Street 1:1905 W BAKER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-1601
Mailing Address - Country:US
Mailing Address - Phone:813-704-6857
Mailing Address - Fax:561-282-0591
Practice Address - Street 1:225 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3469
Practice Address - Country:US
Practice Address - Phone:561-983-8671
Practice Address - Fax:561-983-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy