Provider Demographics
NPI:1902308893
Name:LIGHT ENERGY LLC
Entity Type:Organization
Organization Name:LIGHT ENERGY LLC
Other - Org Name:CHRISTINA LEAVITT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-529-6033
Mailing Address - Street 1:4125 N 3250 W APT 4C
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4574
Mailing Address - Country:US
Mailing Address - Phone:801-529-6033
Mailing Address - Fax:
Practice Address - Street 1:4125 N 3250 W APT 4C
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4574
Practice Address - Country:US
Practice Address - Phone:801-529-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7816855-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty