Provider Demographics
NPI:1891068615
Name:HEATHY LYMPHATICS OF NC PC
Entity Type:Organization
Organization Name:HEATHY LYMPHATICS OF NC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ALBU
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L, CLT-LANA, WC
Authorized Official - Phone:828-355-9584
Mailing Address - Street 1:450 NEW MARKET BOULEVARD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5501
Mailing Address - Country:US
Mailing Address - Phone:828-355-9584
Mailing Address - Fax:828-355-9689
Practice Address - Street 1:800 CHATHAM MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2484
Practice Address - Country:US
Practice Address - Phone:828-355-9584
Practice Address - Fax:828-355-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCOT6615225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2514505AOtherMEDICARE NUMBER