Provider Demographics
NPI:1750418364
Name:THERAPEIA LYMPHEDEMA CENTER, LLC
Entity type:Organization
Organization Name:THERAPEIA LYMPHEDEMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HODGKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:203-230-2800
Mailing Address - Street 1:3074 WHITNEY AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2391
Mailing Address - Country:US
Mailing Address - Phone:203-230-2800
Mailing Address - Fax:203-230-9791
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-230-2800
Practice Address - Fax:203-230-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11116OtherCIGNA
CT0011116OtherHEALTHNET
CT0011116OtherHEALTHNET
CT11116OtherCIGNA
=========OtherNORTHEAST HEALTHCARE
CT11116OtherCIGNA