Provider Demographics
NPI:1164025508
Name:LESTER, MARLA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19314 NW 24TH PL
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5371
Mailing Address - Country:US
Mailing Address - Phone:954-881-8309
Mailing Address - Fax:
Practice Address - Street 1:8040 PETERS RD STE H107
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4029
Practice Address - Country:US
Practice Address - Phone:954-835-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist