Provider Demographics
NPI:1750903100
Name:LIFESTREAM THERAPY INC
Entity type:Organization
Organization Name:LIFESTREAM THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:CHUAH
Authorized Official - Last Name:BIRREY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-319-8335
Mailing Address - Street 1:12292 LONGVIEW LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4965
Mailing Address - Country:US
Mailing Address - Phone:585-319-8335
Mailing Address - Fax:
Practice Address - Street 1:12292 LONGVIEW LAKE CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4965
Practice Address - Country:US
Practice Address - Phone:585-319-8335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy