MEDICARE: LIGHTHOUSE FAMILY THERAPY PROF LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1891622833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE FAMILY THERAPY PROF LLC

Provider Business Mailing Address
First Line	:	1785 NIGHTFALL DR
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-3489
Country	:	US
Telephone Number	:	970-460-6762
Fax Number	:	970-680-7250

Provider Business Practice Location Address
First Line	:	1330 OAKRIDGE DR UNIT 105
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9651
Country	:	US
Telephone Number	:	970-460-6762
Fax Number	:	970-680-7250

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER N BERGIN
Credential	:
Telephone Number	:	303-929-6743

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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