Provider Demographics
NPI:1952459158
Name:LIFESKILLS PHYSICAL THERAPY AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:LIFESKILLS PHYSICAL THERAPY AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SERVICE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:BACHICHA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-470-2082
Mailing Address - Street 1:4152 SOARING EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0817
Mailing Address - Country:US
Mailing Address - Phone:505-470-2082
Mailing Address - Fax:505-473-3100
Practice Address - Street 1:4152 SOARING EAGLE LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0817
Practice Address - Country:US
Practice Address - Phone:505-470-2082
Practice Address - Fax:505-473-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2606251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D4583Medicaid