Provider Demographics
NPI:1417633058
Name:LIVE LIFE WELL LLC
Entity Type:Organization
Organization Name:LIVE LIFE WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:TATE SZYMONIAK-HAGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-495-0402
Mailing Address - Street 1:1502 MIDLANE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3229
Mailing Address - Country:US
Mailing Address - Phone:956-495-0242
Mailing Address - Fax:
Practice Address - Street 1:1502 MIDLANE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3229
Practice Address - Country:US
Practice Address - Phone:956-495-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty