Provider Demographics
NPI:1710324215
Name:LIFETIME THERAPY, LLC
Entity Type:Organization
Organization Name:LIFETIME THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CC-SLP
Authorized Official - Phone:703-507-5525
Mailing Address - Street 1:14573 POTOMAC MILLS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6808
Mailing Address - Country:US
Mailing Address - Phone:703-203-7468
Mailing Address - Fax:
Practice Address - Street 1:14573 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6808
Practice Address - Country:US
Practice Address - Phone:703-203-7468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty