Provider Demographics
NPI:1568716868
Name:LIFETOUCHTHERAPY, PLLC
Entity Type:Organization
Organization Name:LIFETOUCHTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-896-4332
Mailing Address - Street 1:9597 INDIAN BEECH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3573
Mailing Address - Country:US
Mailing Address - Phone:973-896-4332
Mailing Address - Fax:704-793-6308
Practice Address - Street 1:9597 INDIAN BEECH AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3573
Practice Address - Country:US
Practice Address - Phone:973-896-4332
Practice Address - Fax:704-793-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222Q00000X, 251S00000X, 252Y00000X
NC8405224Z00000X
NC6958224Z00000X
NC7879224Z00000X
225100000X
NC7113225X00000X
NC7786225X00000X
NC10501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302158Medicaid
NC7200565Medicaid