MEDICARE: HEALTHY LYMPHATICS, NC PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174400000X	Specialist
2	225X00000X	Occupational Therapist
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1932791506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LYMPHATICS, NC PC

Provider Business Mailing Address
First Line	:	450 NEW MARKET BLVD STE 3
Second Line	:
City	:	BOONE
State	:	NC
Zip	:	28607-5501
Country	:	US
Telephone Number	:	828-355-9584
Fax Number	:	828-355-9689

Provider Business Practice Location Address
First Line	:	113 SCENIC OUTLET LN STE 2
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-9978
Country	:	US
Telephone Number	:	828-355-9584
Fax Number	:	828-355-9689

Authorized Official
Title or Position	:	OWNER
Name	:	CARMEN MARIA ALBU
Credential	:
Telephone Number	:	828-355-9584

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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