Provider Demographics
NPI:1023481991
Name:LIFE REHABILITATION, LC
Entity type:Organization
Organization Name:LIFE REHABILITATION, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L, CLWT, CLT
Authorized Official - Phone:801-993-1110
Mailing Address - Street 1:8134 S SUMMIT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5930
Mailing Address - Country:US
Mailing Address - Phone:801-993-1110
Mailing Address - Fax:
Practice Address - Street 1:8134 S SUMMIT VALLEY DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5930
Practice Address - Country:US
Practice Address - Phone:801-993-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83587964202261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)