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General NPI Number Information
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NPI Number | 1043589625
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Entity Type | Organization
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Legal Business Name | LIGHT TOUCH THERAPIES, INC
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 9790 WALNUT TREE WAY B
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-0662
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Country | US
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Telephone | 561-396-0563
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Fax | 561-423-3109
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Provider Business Mailing Address
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Address Line | 9790 WALNUT TREE WAY B
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-0662
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Country | US
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Telephone | 561-396-0563
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Fax | 561-423-3109
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA A WILHELM
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Credential | LMT
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Telephone | 561-396-0563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | MA21197
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License Number State | FL
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