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General NPI Number Information
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NPI Number | 1700433877
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Entity Type | Individual
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Provider Name | NATHAN J LESSARD DPT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 32246 CLINTON KEITH RD
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City | WILDOMAR
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State | CA
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Zip | 92595-7320
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Country | US
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Telephone | 951-677-7221
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Fax | 951-677-7331
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Provider Business Mailing Address
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Address Line | 32246 CLINTON KEITH RD
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City | WILDOMAR
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State | CA
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Zip | 92595-7320
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Country | US
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Telephone | 951-677-7221
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Fax | 951-677-7331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT03217
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P21108
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 305951
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License Number State | CA
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