Provider Demographics
NPI:1770708968
Name:LIFESPAN THERAPY SERVICES PSC
Entity type:Organization
Organization Name:LIFESPAN THERAPY SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSHING-CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:859-498-8647
Mailing Address - Street 1:318 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1328
Mailing Address - Country:US
Mailing Address - Phone:859-498-8647
Mailing Address - Fax:859-498-8677
Practice Address - Street 1:318 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1328
Practice Address - Country:US
Practice Address - Phone:859-498-8647
Practice Address - Fax:859-498-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT0014592251E1300X
KYR0059225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9130Medicare ID - Type Unspecified