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Organization
LIGHTHOUSE THERAPY SERVICES, INC.
Active
Organization
LIGHTHOUSE THERAPY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JO LEAH PONDER (ASSISTANT OFFICE MANAGER)
(903) 753-8499
Entity
Organization
Contact information
Practice address
822 N 4TH ST, LONGVIEW, TX 75601-5433
(903) 753-8499
(903) 753-8502
Mailing address
822 N 4TH ST, LONGVIEW, TX 75601-5433
(903) 753-8499
(903) 753-8502
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041LJ
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
05/26/2006
Last updated
07/12/2007
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