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Organization
PROFESSIONAL LYMPHEDEMA SERVICES INC
Active
Organization
PROFESSIONAL LYMPHEDEMA SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTEN ANN HANAK P.T. (PRESIDENT)
(386) 882-1161
Entity
Organization
Contact information
Practice address
2568 S RIDGEWOOD AVE, SUITE 3, EDGEWATER, FL 32141-5980
(386) 423-9322
(386) 423-9330
Mailing address
3131 VICTORY PALM DR, EDGEWATER, FL 32141-6129
(386) 882-1161
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT11571
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7809762
PHYSICAL THERAPY
FL
01
—
DE3356
PHYSICAL THERAPY
FL
Enumeration date
06/21/2007
Last updated
11/05/2007
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