The Lymphedemobile PLLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

5556 Issued in AZ

Legal business name

THE LYMPHEDEMOBILE PLLC

Practice address

4446 E Joey Ave
Flagstaff, AZ 86004-2415

Phone

(928) 221-9632

NPI assigned

Apr 16, 2017

Last updated

Apr 16, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Regina Eason, OT, CLTNPI 1336489640

Title

Owner/Manager

Phone

(928) 221-9632

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Regina Eason

  • Occupational Therapist
  • Flagstaff, AZ
  • NPI 1336489640
  NPD (past) Authorized official

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

{
    "created_epoch": "1492300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492300800000",
    "number": "1730613886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4446 E JOEY AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860042415",
            "telephone_number": "928-221-9632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4446 E JOEY AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860042415",
            "telephone_number": "928-221-9632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LYMPHEDEMOBILE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-16",
        "last_updated": "2017-04-16",
        "status": "A",
        "authorized_official_last_name": "EASON",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "928-221-9632",
        "authorized_official_credential": "OT, CLT"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "AZ",
            "license": "5556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Health Service Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2017; 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.