Provider Demographics
NPI:1699100016
Name:LYMPHEDEMA CLINICS OF AMERICA LLC
Entity type:Organization
Organization Name:LYMPHEDEMA CLINICS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-907-8449
Mailing Address - Street 1:PO BOX 826366
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6366
Mailing Address - Country:US
Mailing Address - Phone:302-691-5167
Mailing Address - Fax:302-691-5168
Practice Address - Street 1:701 FOULK RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3733
Practice Address - Country:US
Practice Address - Phone:302-691-5167
Practice Address - Fax:302-691-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2013605008261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy