Organization
LIFESPAN THERAPY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANUSIA KIDANE OTR/L (DIRECTOR)
(505) 954-9940
Entity
Organization
Contact information
Practice address
826 CAMINO DEL MONTE REY STE A2, SANTA FE, NM 87505-3961
(505) 954-9940
(505) 954-9946
Mailing address
826 CAMINO DEL MONTE REY STE A2, SANTA FE, NM 87505-3961
(505) 954-9940
(505) 954-9946
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1011
NM
225X00000X
Occupational Therapist
Primary
1562
NM
235Z00000X
Speech-Language Pathologist
2423
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202006808
PRESBYTERIAN PROVIDER
NM
01
—
A1205
MEDICAID WAIVER PROVIDER
NM
Enumeration date
08/05/2006
Last updated
10/30/2012
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