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General NPI Number Information
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NPI Number | 1407066129
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Entity Type | Organization
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Legal Business Name | ADVANCED LYMPHEDEMA THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 3 CORNER STONE DRIVE SUITE 700
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City | LANGHORNE
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State | PA
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Zip | 19047
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Country | US
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Telephone | 215-750-0501
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Fax | 215-340-1299
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Provider Business Mailing Address
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Address Line | 603 FERRIS LN
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City | DOYLESTOWN
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State | PA
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Zip | 18901-5037
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Country | US
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Telephone | 215-913-0127
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Fax | 215-340-1299
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIMBERLY ANNE KOSCHINEG
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Credential | OTRL
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Telephone | 215-913-0127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OC008082
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License Number State | PA
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