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General NPI Number Information
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NPI Number | 1689483455
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA AND MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 4215 S GRAND CANYON DR STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89147-7173
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Country | US
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Telephone | 702-448-6042
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Fax |
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Provider Business Mailing Address
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Address Line | 8355 LAGUNILLA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89149-4730
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Country | US
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Telephone | 702-580-8125
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRITTANY RONNEBAUM
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Credential | PT, DPT
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Telephone | 702-580-8125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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