Provider Demographics
NPI:1205136769
Name:NEW LIFE THERAPY CENTER INC
Entity type:Organization
Organization Name:NEW LIFE THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-718-8525
Mailing Address - Street 1:3900 NW 79TH AVE STE 461
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6599
Mailing Address - Country:US
Mailing Address - Phone:305-718-8525
Mailing Address - Fax:305-718-8595
Practice Address - Street 1:3900 NW 79TH AVE STE 461
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6599
Practice Address - Country:US
Practice Address - Phone:305-718-8525
Practice Address - Fax:305-718-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25735111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty