MEDICARE: REBECCA LESTER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06004005A	IN

General Provider Information

NPI Number	:	1780009126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LESTER PTA

Provider Business Mailing Address
First Line	:	209 S STATE ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1818
Country	:	US
Telephone Number	:	812-346-1757
Fax Number	:	812-346-3595

Provider Business Practice Location Address
First Line	:	209 S STATE ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1818
Country	:	US
Telephone Number	:	812-346-1757
Fax Number	:	812-346-3595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	02/21/2014

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