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General NPI Number Information
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NPI Number | 1275019861
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE THERAPY CENTER
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1225 GARDEN ISLE CT
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City | ORLANDO
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State | FL
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Zip | 32824-6218
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Country | US
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Telephone | 407-990-2847
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 GARDEN ISLE CT
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City | ORLANDO
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State | FL
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Zip | 32824-6218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SLPA
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Name | MS. INGRID ACOSTA
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Credential | SLPA
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Telephone | 407-990-2847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SI2530
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License Number State | FL
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