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NPI Code Detail

MEDICARE: LUMINESCENCE THERAPY LLC

MEDICARE: LUMINESCENCE THERAPY LLC
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
1235Z00000XSpeech-Language Pathologist
2225X00000XOccupational Therapist
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1700508041
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUMINESCENCE THERAPY LLC
Provider Business Mailing Address
First Line : 13424 FORT KING RD
Second Line :
City : DADE CITY
State : FL
Zip : 33525-5214
Country : US
Telephone Number : 352-437-3559
Fax Number : 352-608-9017
Provider Business Practice Location Address
First Line : 13424 FORT KING RD
Second Line :
City : DADE CITY
State : FL
Zip : 33525-5214
Country : US
Telephone Number : 352-437-3559
Fax Number : 352-608-9017
Authorized Official
Title or Position : PRESIDENT
Name : VIOLET T REID
Credential : BCBA
Telephone Number : 561-900-8199
Provider Enumeration Date : 09/14/2022
Last Update Date : 12/02/2025

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Directions to “LUMINESCENCE THERAPY LLC ” Practice Location

Language Start Address Practice Location
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