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NPI Code Detail

MEDICARE: LIGHTHOUSE THERAPY CENTER OF FORT WORTH

MEDICARE: LIGHTHOUSE THERAPY CENTER OF FORT WORTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1447999032
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE THERAPY CENTER OF FORT WORTH
Provider Business Mailing Address
First Line : 7904 VISTA RIDGE DR S
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4530
Country : US
Telephone Number : 469-460-5237
Fax Number :
Provider Business Practice Location Address
First Line : 6421 CAMP BOWIE BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5419
Country : US
Telephone Number : 469-460-5237
Fax Number : 817-717-5169
Authorized Official
Title or Position : OWNER
Name : ASHLYN WIMMER
Credential :
Telephone Number : 469-460-5237
Provider Enumeration Date : 06/01/2022
Last Update Date : 02/25/2026

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Directions to “LIGHTHOUSE THERAPY CENTER OF FORT WORTH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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