Provider Demographics
NPI:1720814213
Name:LIGHT, CAMERON EDWARD (DPT, PT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:EDWARD
Last Name:LIGHT
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COLONNADE ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5182
Mailing Address - Country:US
Mailing Address - Phone:276-340-2652
Mailing Address - Fax:
Practice Address - Street 1:44 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1422
Practice Address - Country:US
Practice Address - Phone:434-528-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist