Provider Demographics
NPI:1275558173
Name:SMITH, LESTER STEPHEN (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:STEPHEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 N FIELD ST APT 1945
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1772
Mailing Address - Country:US
Mailing Address - Phone:214-880-7537
Mailing Address - Fax:
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:SUITE G21
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-981-7286
Practice Address - Fax:972-981-3209
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT03952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer