Healthcare Provider Details

I. General information

NPI: 1366771354
Provider Name (Legal Business Name): LYMPHEDEMA SOLUTIONS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MOCKSVILLE AVE
SALISBURY NC
28144-3328
US

IV. Provider business mailing address

220 BERNHARDT RD
SALISBURY NC
28147-9602
US

V. Phone/Fax

Practice location:
  • Phone: 704-213-4952
  • Fax: 704-636-9788
Mailing address:
  • Phone: 704-213-4952
  • Fax: 704-636-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2490
License Number StateNC

VIII. Authorized Official

Name: MRS. PAM JOYCE ROSEMAN
Title or Position: PRESIDENT
Credential: PT
Phone: 704-213-4952