Provider Demographics
NPI:1083893093
Name:LIGHT, BARBARA A (LMP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7713
Mailing Address - Country:US
Mailing Address - Phone:360-681-4730
Mailing Address - Fax:
Practice Address - Street 1:2975 RIVER RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-7713
Practice Address - Country:US
Practice Address - Phone:360-681-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist