Provider Demographics
NPI:1083239271
Name:GREENLIGHT THERAPY LLC
Entity Type:Organization
Organization Name:GREENLIGHT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-977-3927
Mailing Address - Street 1:8925 W FLAMINGO RD UNIT 314
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-0449
Mailing Address - Country:US
Mailing Address - Phone:732-977-3927
Mailing Address - Fax:
Practice Address - Street 1:8925 W FLAMINGO RD UNIT 314
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0449
Practice Address - Country:US
Practice Address - Phone:732-977-3927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty