Provider Demographics
NPI:1619360039
Name:CENTRAL COAST LYMPHEDEMA
Entity Type:Organization
Organization Name:CENTRAL COAST LYMPHEDEMA
Other - Org Name:TEMPLETON LYMPHEDEMA THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CINOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT-DPT, CLT
Authorized Official - Phone:312-451-9566
Mailing Address - Street 1:3271 S HIGUERA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-1205
Mailing Address - Country:US
Mailing Address - Phone:805-782-9300
Mailing Address - Fax:805-782-9700
Practice Address - Street 1:3271 S HIGUERA ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-1205
Practice Address - Country:US
Practice Address - Phone:057-829-3008
Practice Address - Fax:805-782-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35961225100000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty