Provider Demographics
NPI:1215496450
Name:LIFETIME BODY AND HEALTH AWARENESS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:LIFETIME BODY AND HEALTH AWARENESS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT,CEEAA
Authorized Official - Phone:702-831-8076
Mailing Address - Street 1:1489 W WARM SPRINGS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7367
Mailing Address - Country:US
Mailing Address - Phone:725-286-7997
Mailing Address - Fax:888-414-7996
Practice Address - Street 1:1489 W WARM SPRINGS RD STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7367
Practice Address - Country:US
Practice Address - Phone:725-286-7997
Practice Address - Fax:888-414-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty