Provider Demographics
NPI:1194801670
Name:TLC LYMPHEDEMA AND PHYSICAL THERAPYPLLC
Entity type:Organization
Organization Name:TLC LYMPHEDEMA AND PHYSICAL THERAPYPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:469-330-7762
Mailing Address - Street 1:12606 GREENVILLE AVE STE 284
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1921
Mailing Address - Country:US
Mailing Address - Phone:469-330-7762
Mailing Address - Fax:469-330-7764
Practice Address - Street 1:12606 GREENVILLE AVE STE 284
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1921
Practice Address - Country:US
Practice Address - Phone:469-330-7762
Practice Address - Fax:469-330-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty