=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841097391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY LYMPHATICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 BUFORD BLVD STE A
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-4668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-408-4848
-----------------------------------------------------
Fax | 772-408-0978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 479 NW PRIMA VISTA BLVD
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34983-8731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-408-4848
-----------------------------------------------------
Fax | 772-408-0978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | TONI SALTMARSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-204-3792
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------