Provider Demographics
NPI:1508171265
Name:LIFE THERAPY CORP.
Entity Type:Organization
Organization Name:LIFE THERAPY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-825-3666
Mailing Address - Street 1:900 W 49TH ST STE 505
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3488
Mailing Address - Country:US
Mailing Address - Phone:305-331-2088
Mailing Address - Fax:305-825-3663
Practice Address - Street 1:900 W 49TH ST STE 505
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3488
Practice Address - Country:US
Practice Address - Phone:305-331-2088
Practice Address - Fax:305-825-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8914OtherAHCA