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General NPI Number Information
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NPI Number | 1700508041
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Entity Type | Organization
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Legal Business Name | LUMINESCENCE THERAPY LLC
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 13424 FORT KING RD
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City | DADE CITY
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State | FL
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Zip | 33525-5214
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Country | US
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Telephone | 352-437-3559
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Fax | 352-608-9017
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Provider Business Mailing Address
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Address Line | 13424 FORT KING RD
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City | DADE CITY
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State | FL
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Zip | 33525-5214
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Country | US
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Telephone | 352-437-3559
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Fax | 352-608-9017
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIOLET T REID
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Credential | BCBA
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Telephone | 561-900-8199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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