MEDICARE: LIGHTHOUSE THERAPY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center	SI2530	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275019861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE THERAPY CENTER

Provider Business Mailing Address
First Line	:	1225 GARDEN ISLE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-6218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 GARDEN ISLE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-6218
Country	:	US
Telephone Number	:	407-990-2847
Fax Number	:

Authorized Official
Title or Position	:	SLPA
Name	:	MS. INGRID ACOSTA
Credential	:	SLPA
Telephone Number	:	407-990-2847

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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Directions to “LIGHTHOUSE THERAPY CENTER ” Practice Location

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