Provider Demographics
NPI:1972964708
Name:LIFEWORKS UNILIMITED PEDIATRIC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:LIFEWORKS UNILIMITED PEDIATRIC THERAPY SERVICES, LLC
Other - Org Name:LIFEWORKS UNLIMITED PTS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ADELFA
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:786-217-7544
Mailing Address - Street 1:1009 FLAMELEAF CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8611
Mailing Address - Country:US
Mailing Address - Phone:336-946-6313
Mailing Address - Fax:336-776-0099
Practice Address - Street 1:1009 FLAMELEAF CT
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-8611
Practice Address - Country:US
Practice Address - Phone:336-946-6313
Practice Address - Fax:336-776-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9318224Z00000X
NCP151792251P0200X, 2251P0200X
NCA5565225200000X
NC6431225X00000X, 225XP0200X, 261QM1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00541818Medicaid
NC00541818Medicaid