Provider Demographics
NPI:1548531890
Name:LIGHT CONNECTION INC
Entity type:Organization
Organization Name:LIGHT CONNECTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-543-8878
Mailing Address - Street 1:112 E MYRTLE AVE
Mailing Address - Street 2:STE 312
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-8600
Mailing Address - Country:US
Mailing Address - Phone:423-737-1151
Mailing Address - Fax:
Practice Address - Street 1:112 E MYRTLE AVE
Practice Address - Street 2:STE 312
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-8600
Practice Address - Country:US
Practice Address - Phone:423-737-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty