NPIMap

Organization Active NPI

Therapeutic Life Center, Inc.

  • Occupational Therapist
  • Greenville, NC
National Provider Identifier
1275559759
Registry record updated Apr 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
THERAPEUTIC LIFE CENTER, INC.
Practice address
102 Eastbrook Dr
Suite C
Greenville, NC 27858-4320
Phone
(252) 830-0245
Fax
(252) 830-0247
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeanne C Rosal, OTR/L
Title
Owner/Occupational Therapist
Phone
(252) 830-0245

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

102 Eastbrook Dr
Suite C
Greenville, NC 27858-4320

Mailing address

102 Eastbrook Drive
B and C
Greenville, NC 27858-4320
Phone (252) 830-0245

Other identifiers 2

IdentifierTypeStateIssuer
012XUOtherNCBCBS-OT & PT SERVICES
7211029MedicaidNC

National Provider Directory

National Provider Directory

Locations

2706 E 10th St
Ste A
Greenville, NC 27858
Phone (252) 830-0245

102 Eastbrook Dr
Ste C
Greenville, NC 27858
Phone (252) 830-0245

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335398400000",
    "number": "1275559759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 EASTBROOK DRIVE",
            "address_2": "B AND C",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278584320",
            "telephone_number": "252-830-0245",
            "fax_number": "252-830-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 EASTBROOK DR",
            "address_2": "SUITE C",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278584320",
            "telephone_number": "252-830-0245",
            "fax_number": "252-830-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTIC LIFE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2012-04-26",
        "status": "A",
        "authorized_official_last_name": "ROSAL",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "252-830-0245",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-OT & PT SERVICES",
            "identifier": "012XU",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7211029",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.