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General NPI Number Information
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NPI Number | 1801557541
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PILATES & PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 4435 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3513
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Country | US
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Telephone | 954-391-8823
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Fax |
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Provider Business Mailing Address
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Address Line | 4315 POLK ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6615
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Country | US
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Telephone | 954-699-4690
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MARY EBANKS-NUNAIHED
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Credential | DPT
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Telephone | 954-391-8823
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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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