Provider Demographics
NPI:1417295817
Name:LESTER, JAMIE (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S BROAD ST
Mailing Address - Street 2:SUITE 1833
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19109-1029
Mailing Address - Country:US
Mailing Address - Phone:215-776-9663
Mailing Address - Fax:
Practice Address - Street 1:123 S BROAD ST
Practice Address - Street 2:SUITE 1833
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19109-1029
Practice Address - Country:US
Practice Address - Phone:215-776-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011527225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist