Provider Demographics
NPI:1689849978
Name:THE MUSCLE THERAPY CLINIC
Entity Type:Organization
Organization Name:THE MUSCLE THERAPY CLINIC
Other - Org Name:MIRTHA PATRICIA LIGHTSEY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:LIGHTSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-769-0945
Mailing Address - Street 1:2220 COIT RD STE 510
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3783
Mailing Address - Country:US
Mailing Address - Phone:972-769-0945
Mailing Address - Fax:972-398-3299
Practice Address - Street 1:2220 COIT RD STE 510
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3783
Practice Address - Country:US
Practice Address - Phone:972-769-0945
Practice Address - Fax:972-398-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7902111N00000X
TXMT025368172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821015736OtherNPI
TX1073504387OtherNPI