Provider Demographics
NPI:1821015736
Name:LIGHTSEY, MIRTHA PATRICIA (LMT, RMT)
Entity Type:Individual
Prefix:MRS
First Name:MIRTHA
Middle Name:PATRICIA
Last Name:LIGHTSEY
Suffix:
Gender:F
Credentials:LMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT25368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX(940)380-4078OtherAETNA PIN
TX0016NROtherBLUE CROSS - CLINIC PIN
TX666606OtherUNITED HEALTHCARE PIN