Provider Demographics
NPI:1659969285
Name:LYMPHEDEMA THERAPY SPECIALISTS INC.
Entity Type:Organization
Organization Name:LYMPHEDEMA THERAPY SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BHARVI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-497-5335
Mailing Address - Street 1:1333 OLD SPANISH TRL STE G304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1849
Mailing Address - Country:US
Mailing Address - Phone:713-497-5335
Mailing Address - Fax:833-891-3211
Practice Address - Street 1:705 S FRY RD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2252
Practice Address - Country:US
Practice Address - Phone:281-676-4199
Practice Address - Fax:281-676-4227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYMPHEDEMA THERAPY SPECIALISTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy