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General NPI Number Information
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NPI Number | 1992468839
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Entity Type | Organization
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Legal Business Name | LUNA LYMPHATIC CARE
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 3104 BRIDGEBORO RD STE B
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City | DELRAN
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State | NJ
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Zip | 08075-9716
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Country | US
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Telephone | 856-910-8089
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Fax |
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Provider Business Mailing Address
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Address Line | 12 E CEDAR AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2502
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Country | US
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Telephone | 609-707-5655
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Fax | 856-910-0046
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | MRS. LYNN DAVIS
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Credential | MPT
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Telephone | 609-707-5655
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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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