Provider Demographics
NPI:1669102885
Name:LYMPHATIC CARE AND WELLNESS LLC
Entity type:Organization
Organization Name:LYMPHATIC CARE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL & MASSAGE THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DASRATH
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L, LMT
Authorized Official - Phone:386-965-3036
Mailing Address - Street 1:5208 SW 91ST DR STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3006
Mailing Address - Country:US
Mailing Address - Phone:352-235-9471
Mailing Address - Fax:
Practice Address - Street 1:5208 SW 91ST DR STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3006
Practice Address - Country:US
Practice Address - Phone:386-965-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service