Provider Demographics
NPI:1366771354
Name:LYMPHEDEMA SOLUTIONS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:LYMPHEDEMA SOLUTIONS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:ROSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-213-4952
Mailing Address - Street 1:220 BERNHARDT RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-9602
Mailing Address - Country:US
Mailing Address - Phone:704-213-4952
Mailing Address - Fax:704-636-9788
Practice Address - Street 1:322 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3328
Practice Address - Country:US
Practice Address - Phone:704-213-4952
Practice Address - Fax:704-636-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2490261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2506118AMedicare PIN