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General NPI Number Information
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NPI Number | 1861200073
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA CLINIX TEXAS LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2128 BABCOCK RD BLDG 2 SUITE A
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-201-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 4337 W OXFORD ST
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City | CEDAR HILLS
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State | UT
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Zip | 84062-8638
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Country | US
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Telephone | 210-201-5433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SPENCER CLARK
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Credential |
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Telephone | 210-201-5433
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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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