Provider Demographics
NPI:1215252390
Name:LIFE-SPAN NEURO-DEVELOPMENTAL THERAPY INC
Entity type:Organization
Organization Name:LIFE-SPAN NEURO-DEVELOPMENTAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-422-6387
Mailing Address - Street 1:1700 E SANDUSKY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6463
Mailing Address - Country:US
Mailing Address - Phone:419-424-6387
Mailing Address - Fax:419-425-7055
Practice Address - Street 1:1700 E SANDUSKY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6463
Practice Address - Country:US
Practice Address - Phone:419-422-6387
Practice Address - Fax:419-425-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty