Healthcare Provider Details

I. General information

NPI: 1013121227
Provider Name (Legal Business Name): LISA G LESTER CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 N WICKHAM RD SUITE 112
MELBOURNE FL
32940-7534
US

IV. Provider business mailing address

4475 DELESPINE RD
COCOA FL
32927-3513
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-1046
  • Fax: 321-253-3119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT12272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: