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General NPI Number Information
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NPI Number | 1497204630
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA AND REHABILITATION CONSULTANTS ,PLLC
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 2916 RIDGEGATE PL
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City | GLEN ALLEN
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State | VA
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Zip | 23059-4682
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Country | US
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Telephone | 517-918-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 2916 RIDGEGATE PL
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City | GLEN ALLEN
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State | VA
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Zip | 23059-4682
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Country | US
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Telephone | 804-505-4849
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Fax | 844-715-9467
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KIRAT S SHAH
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Credential | PT
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Telephone | 804-505-4849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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