Provider Demographics
NPI:1245562057
Name:LIFESPAN REHABILITATION LLC
Entity Type:Organization
Organization Name:LIFESPAN REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OTR
Authorized Official - Phone:772-643-2939
Mailing Address - Street 1:5083 4TH LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-1865
Mailing Address - Country:US
Mailing Address - Phone:772-643-2939
Mailing Address - Fax:
Practice Address - Street 1:5083 4TH LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-1865
Practice Address - Country:US
Practice Address - Phone:772-643-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11964251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health