Provider Demographics
NPI:1912193871
Name:LIGHT THERAPY PRODUCTS
Entity Type:Organization
Organization Name:LIGHT THERAPY PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. SALES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:I
Authorized Official - Last Name:HAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-351-9800
Mailing Address - Street 1:5623 MEMORIAL AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1092
Mailing Address - Country:US
Mailing Address - Phone:651-351-9800
Mailing Address - Fax:651-351-9804
Practice Address - Street 1:5623 MEMORIAL AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1092
Practice Address - Country:US
Practice Address - Phone:651-351-9800
Practice Address - Fax:651-351-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies