Lymphedema Treatment Center LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT12323 Issued in FL

Legal business name

LYMPHEDEMA TREATMENT CENTER LLC

Practice address

11512 Lake Mead Ave Unit 604
Jacksonville, FL 32256-9686

Phone

(904) 425-4391

Fax

(904) 425-4392

NPI assigned

Feb 22, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rose Marsha Corrales, OTR/L

Title

Owner/ Therapist

Phone

(904) 425-4391

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1609045756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569686",
            "telephone_number": "904-425-4391",
            "fax_number": "904-425-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569686",
            "telephone_number": "904-425-4391",
            "fax_number": "904-425-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYMPHEDEMA TREATMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-22",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "CORRALES",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "MARSHA",
        "authorized_official_title_or_position": "OWNER/ THERAPIST",
        "authorized_official_telephone_number": "904-425-4391",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT12323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Leigh Lyles, APRN
• Brittney Lyles
• Jason K Lyles, PA
• Lymphedema Care Center of North Florida, Inc.
• Lymphedema Care Center of North Florida, Inc.
• Brian Lynch, CRNA
• Davene Lynch
• Elizabeth Lynch, RPH
• Gretchen Lynch
• Katherine Lynch, OTR/L

• Occupational Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.