Provider Demographics
NPI:1043666571
Name:LIGHTY, RACHEL (SCMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LIGHTY
Suffix:
Gender:F
Credentials:SCMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S 500 E
Mailing Address - Street 2:APT. 419
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-4004
Mailing Address - Country:US
Mailing Address - Phone:319-541-9611
Mailing Address - Fax:
Practice Address - Street 1:343 S 500 E
Practice Address - Street 2:APT. 419
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4004
Practice Address - Country:US
Practice Address - Phone:319-541-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist