Provider Demographics
NPI:1508509696
Name:LYMPHATIC THERAPY CLINIC LLC
Entity Type:Organization
Organization Name:LYMPHATIC THERAPY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:PHILECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-542-4551
Mailing Address - Street 1:201 W BELT LINE RD STE C600
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2050
Mailing Address - Country:US
Mailing Address - Phone:469-895-4068
Mailing Address - Fax:
Practice Address - Street 1:201 W BELT LINE RD STE C600
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2050
Practice Address - Country:US
Practice Address - Phone:214-542-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-16
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty