Provider Demographics
NPI:1710580816
Name:BLIGHT, ELIZABETH RUTH (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RUTH
Last Name:BLIGHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 NEEDMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4537
Mailing Address - Country:US
Mailing Address - Phone:385-253-3116
Mailing Address - Fax:
Practice Address - Street 1:1721 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4537
Practice Address - Country:US
Practice Address - Phone:385-553-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist