Provider Demographics
NPI:1306160908
Name:BEST LIFE THERAPY LLC
Entity type:Organization
Organization Name:BEST LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:LORENN
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC/SLP
Authorized Official - Phone:304-657-0551
Mailing Address - Street 1:141 STATE ST.
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-0000
Mailing Address - Country:US
Mailing Address - Phone:305-657-0551
Mailing Address - Fax:
Practice Address - Street 1:141 STATE ST.
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-0000
Practice Address - Country:US
Practice Address - Phone:305-657-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016421Medicaid