Provider Demographics
NPI:1225696628
Name:TOWNSEND, LIGHT
Entity Type:Individual
Prefix:
First Name:LIGHT
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 LA POSADA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3842
Mailing Address - Country:US
Mailing Address - Phone:512-284-7192
Mailing Address - Fax:
Practice Address - Street 1:1033 LA POSADA DR STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3842
Practice Address - Country:US
Practice Address - Phone:512-284-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant