Provider Demographics
NPI:1992468839
Name:LUNA LYMPHATIC CARE
Entity Type:Organization
Organization Name:LUNA LYMPHATIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:609-707-5655
Mailing Address - Street 1:12 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2502
Mailing Address - Country:US
Mailing Address - Phone:609-707-5655
Mailing Address - Fax:856-910-0046
Practice Address - Street 1:801 ROUTE 73 N STE G
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1283
Practice Address - Country:US
Practice Address - Phone:856-910-8089
Practice Address - Fax:856-910-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty