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General NPI Number Information
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NPI Number | 1104110840
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Entity Type | Organization
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Legal Business Name | NEW LIGHT THERAPY
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Dates
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Enumeration Date | 05/28/2011
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 2869 ESAW ST
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City | MINDEN
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State | NV
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Zip | 89423-9059
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Country | US
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Telephone | 775-235-8809
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Fax | 775-420-4675
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Provider Business Mailing Address
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Address Line | 1329 HWY 395 SUITE 10-274
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City | GARDNERVILLE
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State | NV
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Zip | 89410
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Country | US
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Telephone | 775-235-8809
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Fax | 775-420-4675
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ERIN VAILLANCOURT
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Credential | D.P.T.
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Telephone | 775-235-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | NV20101224552
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License Number State | NV
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