Provider Demographics
NPI:1821291964
Name:LYMPHEDEMA PHYSIOTHERAPY
Entity Type:Organization
Organization Name:LYMPHEDEMA PHYSIOTHERAPY
Other - Org Name:NEPTUNE ENGINEERING CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZZAQ
Authorized Official - Suffix:
Authorized Official - Credentials:DSC, LLCC, CMT
Authorized Official - Phone:757-615-2124
Mailing Address - Street 1:4128 CHESWICK LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6559
Mailing Address - Country:US
Mailing Address - Phone:757-615-2124
Mailing Address - Fax:
Practice Address - Street 1:4301 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1250
Practice Address - Country:US
Practice Address - Phone:757-615-2124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019 005511302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization