Provider Demographics
NPI:1750931861
Name:ADVANCED LYMPHEDEMA AND REHAB
Entity type:Organization
Organization Name:ADVANCED LYMPHEDEMA AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:586-441-2222
Mailing Address - Street 1:312 KIRKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9221
Mailing Address - Country:US
Mailing Address - Phone:586-441-2222
Mailing Address - Fax:
Practice Address - Street 1:312 KIRKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9221
Practice Address - Country:US
Practice Address - Phone:586-441-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy