Provider Demographics
NPI:1013710441
Name:THE LYMPHEDEMA CENTER, LLC
Entity type:Organization
Organization Name:THE LYMPHEDEMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLT-LANA
Authorized Official - Phone:229-848-0050
Mailing Address - Street 1:1401 US HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3203
Mailing Address - Country:US
Mailing Address - Phone:229-387-8377
Mailing Address - Fax:229-387-8370
Practice Address - Street 1:1401 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3203
Practice Address - Country:US
Practice Address - Phone:229-387-8377
Practice Address - Fax:229-387-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty