Provider Demographics
NPI:1225653744
Name:LIFT OFF THERAPY CENTER LLC
Entity Type:Organization
Organization Name:LIFT OFF THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-601-2748
Mailing Address - Street 1:403 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2121
Mailing Address - Country:US
Mailing Address - Phone:610-601-2748
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:121 N WAYNE AVE STE 304
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3542
Practice Address - Country:US
Practice Address - Phone:610-601-2748
Practice Address - Fax:508-433-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty