=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124817408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYMPH FIT CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2025
-----------------------------------------------------
Last Update Date | 05/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8820 COLUMBIA 100 PKWY STE 215
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-741-1158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8820 COLUMBIA 100 PKWY STE 215
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-741-1158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | GEETA SANTOSH NATH
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 443-741-1158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------