Provider Demographics
NPI:1659407856
Name:LYMPHATIC THERAPY SERVICES INC
Entity Type:Organization
Organization Name:LYMPHATIC THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MATZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:702-367-6015
Mailing Address - Street 1:3560 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1115
Mailing Address - Country:US
Mailing Address - Phone:702-367-6015
Mailing Address - Fax:702-367-0614
Practice Address - Street 1:3560 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1115
Practice Address - Country:US
Practice Address - Phone:702-367-6015
Practice Address - Fax:702-367-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402377Medicaid
NVV36172Medicare ID - Type UnspecifiedJOANNE MATZ OTR
P26631Medicare UPIN