Provider Demographics
NPI:1508056961
Name:LIGHTHOUSE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-376-8020
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-0936
Mailing Address - Country:US
Mailing Address - Phone:606-376-8020
Mailing Address - Fax:606-376-8055
Practice Address - Street 1:1200 NORTH HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653
Practice Address - Country:US
Practice Address - Phone:606-376-8020
Practice Address - Fax:606-376-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000953261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy