Provider Demographics
NPI:1801557541
Name:LIGHTHOUSE PILATES & PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE PILATES & PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBANKS-NUNAIHED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-391-8823
Mailing Address - Street 1:4315 POLK ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6615
Mailing Address - Country:US
Mailing Address - Phone:954-699-4690
Mailing Address - Fax:
Practice Address - Street 1:4435 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3513
Practice Address - Country:US
Practice Address - Phone:954-391-8823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty