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General NPI Number Information
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NPI Number | 1699100016
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA CLINICS OF AMERICA LLC
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 701 FOULK RD SUITE 1B
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City | WILMINGTON
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State | DE
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Zip | 19803-3733
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Country | US
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Telephone | 302-691-5167
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Fax | 302-691-5168
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Provider Business Mailing Address
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Address Line | PO BOX 826366
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City | PHILADELPHIA
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State | PA
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Zip | 19182-6366
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Country | US
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Telephone | 302-691-5167
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Fax | 302-691-5168
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. CAROLINE E LOGAN
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Credential |
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Telephone | 443-907-8449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2013605008
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License Number State | DE
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