Provider Demographics
NPI:1336447036
Name:LIGHTHOUSE PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:G
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:843-442-1152
Mailing Address - Street 1:932 EQUESTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3608
Mailing Address - Country:US
Mailing Address - Phone:843-442-1152
Mailing Address - Fax:843-388-7491
Practice Address - Street 1:932 EQUESTRIAN DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3608
Practice Address - Country:US
Practice Address - Phone:843-442-1152
Practice Address - Fax:843-388-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty