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General NPI Number Information
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NPI Number | 1750772521
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR LYMPHATIC THERAPY
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 3901 NW 79TH AVE STE 122
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City | DORAL
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State | FL
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Zip | 33166-6554
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Country | US
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Telephone | 319-855-8098
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 SW 152ND PL
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City | MIAMI
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State | FL
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Zip | 33193-2159
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Country | US
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Telephone | 319-855-8098
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. MELISSA A HERNANDEZ
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Credential |
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Telephone | 319-855-8098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 16667
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License Number State | FL
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