Provider Demographics
NPI:1720879646
Name:LIGHTHOUSE MASSAGE AND YOGA
Entity type:Organization
Organization Name:LIGHTHOUSE MASSAGE AND YOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-622-0123
Mailing Address - Street 1:300 S BRIDGE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-1590
Mailing Address - Country:US
Mailing Address - Phone:517-622-0123
Mailing Address - Fax:517-622-0123
Practice Address - Street 1:300 S BRIDGE ST FL 3
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1590
Practice Address - Country:US
Practice Address - Phone:517-622-0123
Practice Address - Fax:517-622-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty