Provider Demographics
NPI:1598364143
Name:LIGHTHOUSE PHYSICAL THERAPY AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:LIGHTHOUSE PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:LIGHTHOUSE PT & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-928-3443
Mailing Address - Street 1:18915 E APPLEWAY AVE A200
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-0000
Mailing Address - Country:US
Mailing Address - Phone:509-928-3443
Mailing Address - Fax:509-891-5591
Practice Address - Street 1:18915 E APPLEWAY AVE A200
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:WA
Practice Address - Zip Code:99016-0000
Practice Address - Country:US
Practice Address - Phone:509-928-3443
Practice Address - Fax:509-891-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty