Provider Demographics
NPI:1407526155
Name:LYMPHEDEMA TREATMENT CENTER
Entity Type:Organization
Organization Name:LYMPHEDEMA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-768-9984
Mailing Address - Street 1:250 W INDIANTOWN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 W INDIANTOWN RD STE 106
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3549
Practice Address - Country:US
Practice Address - Phone:561-768-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty