Healthcare Provider Details

I. General information

NPI: 1164076832
Provider Name (Legal Business Name): LIGHT THE WAY PEDIATRIC THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MANOR AVE STE 204
BARDSTOWN KY
40004-2800
US

IV. Provider business mailing address

130 CHESTER HAHN RD
BLOOMFIELD KY
40008-7014
US

V. Phone/Fax

Practice location:
  • Phone: 502-233-1305
  • Fax: 502-509-0612
Mailing address:
  • Phone: 862-268-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LYNN LYNCH
Title or Position: OWNER, SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 862-268-6139