Provider Demographics
NPI:1497204630
Name:LYMPHEDEMA AND REHABILITATION CONSULTANTS ,PLLC
Entity Type:Organization
Organization Name:LYMPHEDEMA AND REHABILITATION CONSULTANTS ,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-505-4849
Mailing Address - Street 1:2916 RIDGEGATE PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4682
Mailing Address - Country:US
Mailing Address - Phone:804-505-4849
Mailing Address - Fax:844-715-9467
Practice Address - Street 1:2916 RIDGEGATE PL
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4682
Practice Address - Country:US
Practice Address - Phone:517-918-4849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty