Provider Demographics
NPI:1306017900
Name:LYMPHEDEMA CARE CENTER OF AMERICA
Entity Type:Organization
Organization Name:LYMPHEDEMA CARE CENTER OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L-CLT
Authorized Official - Phone:954-295-4276
Mailing Address - Street 1:3060 NE 190TH ST
Mailing Address - Street 2:# 101
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3130
Mailing Address - Country:US
Mailing Address - Phone:954-295-4276
Mailing Address - Fax:305-466-2967
Practice Address - Street 1:3060 NE 190TH ST
Practice Address - Street 2:# 101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3130
Practice Address - Country:US
Practice Address - Phone:954-295-4276
Practice Address - Fax:305-466-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty