Provider Demographics
NPI:1508477068
Name:LIFESTYLE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LIFESTYLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-485-2028
Mailing Address - Street 1:6940 NEWBURY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4500
Mailing Address - Country:US
Mailing Address - Phone:651-485-2028
Mailing Address - Fax:651-688-0957
Practice Address - Street 1:6940 NEWBURY RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4500
Practice Address - Country:US
Practice Address - Phone:651-485-2028
Practice Address - Fax:651-688-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty