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General NPI Number Information
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NPI Number | 1508509696
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Entity Type | Organization
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Legal Business Name | LYMPHATIC THERAPY CLINIC LLC
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Dates
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Enumeration Date | 04/16/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 201 W BELT LINE RD STE C600
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City | CEDAR HILL
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State | TX
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Zip | 75104-2050
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Country | US
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Telephone | 214-542-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W BELT LINE RD STE C600
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City | CEDAR HILL
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State | TX
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Zip | 75104-2050
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Country | US
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Telephone | 469-895-4068
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/COO
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Name | PHILECIA VASSELL
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Credential | PT
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Telephone | 214-542-4551
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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