Healthcare Provider Details

I. General information

NPI: 1700508041
Provider Name (Legal Business Name): LUMINESCENCE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13424 FORT KING RD
DADE CITY FL
33525-5214
US

IV. Provider business mailing address

10040 PO BOX
BROOKSVILLE FL
36103
US

V. Phone/Fax

Practice location:
  • Phone: 352-437-3559
  • Fax: 352-608-9017
Mailing address:
  • Phone: 352-437-3559
  • Fax: 352-608-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: VIOLET T REID
Title or Position: PRESIDENT
Credential: BCBA
Phone: 561-900-8199