MEDICARE: LYMPHEDEMA AND REHABILITATION CONSULTANTS ,PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1497204630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYMPHEDEMA AND REHABILITATION CONSULTANTS ,PLLC

Provider Business Mailing Address
First Line	:	2916 RIDGEGATE PL
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-4682
Country	:	US
Telephone Number	:	804-505-4849
Fax Number	:	844-715-9467

Provider Business Practice Location Address
First Line	:	2916 RIDGEGATE PL
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-4682
Country	:	US
Telephone Number	:	517-918-4849
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. KIRAT S SHAH
Credential	:	PT
Telephone Number	:	804-505-4849

Provider Enumeration Date	:	09/29/2016
Last Update Date	:	08/26/2019

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