Basic Information
| Provider Information | |||||||||
| NPI: | 1275961567 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIFESPAN THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460322923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175731037 | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460322923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175731037 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | DOSECK | ||||||||
| AuthorizedOfficialFirstName: | BETHANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PTA | ||||||||
| AuthorizedOfficialTelephone: | 3175731037 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEART OF CARDON | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 06004741A | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.