Provider Demographics
NPI:1568654739
Name:NEW LIFE THERAPY GROUP, INC
Entity Type:Organization
Organization Name:NEW LIFE THERAPY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:407-619-5427
Mailing Address - Street 1:5703 RED BUG LAKE RD # 177
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4969
Mailing Address - Country:US
Mailing Address - Phone:407-619-5427
Mailing Address - Fax:
Practice Address - Street 1:968 TROON TRCE
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4318
Practice Address - Country:US
Practice Address - Phone:407-619-5427
Practice Address - Fax:321-348-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty