Organization
THERAPEUTIC LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE C ROSAL OTR/L (OWNER/OCCUPATIONAL THERAPIST)
(252) 830-0245
Entity
Organization
Contact information
Practice address
102 EASTBROOK DR, SUITE C, GREENVILLE, NC 27858-4320
(252) 830-0245
(252) 830-0247
Mailing address
102 EASTBROOK DRIVE, B AND C, GREENVILLE, NC 27858-4320
(252) 830-0245
(252) 830-0247
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012XU
BCBS-OT & PT SERVICES
NC
05
—
7211029
—
NC
Enumeration date
07/15/2006
Last updated
04/26/2012
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