MEDICARE: CENTRAL COAST LYMPHEDEMA

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	225100000X	Physical Therapist	35961	CA

General Provider Information

NPI Number	:	1619360039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL COAST LYMPHEDEMA

Provider Business Mailing Address
First Line	:	3271 S HIGUERA ST STE 102
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-1205
Country	:	US
Telephone Number	:	805-782-9300
Fax Number	:	805-782-9700

Provider Business Practice Location Address
First Line	:	3271 S HIGUERA ST STE 102
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-1205
Country	:	US
Telephone Number	:	57-829-3008
Fax Number	:	805-782-9700

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. JAMIE ELIZABETH CINOTTO
Credential	:	PT-DPT, CLT
Telephone Number	:	312-451-9566

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	05/22/2023

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Directions to “CENTRAL COAST LYMPHEDEMA ” Practice Location

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