Provider Demographics
NPI:1609954684
Name:STROOP, LESA TRAVIS
Entity Type:Individual
Prefix:MR
First Name:LESA
Middle Name:TRAVIS
Last Name:STROOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SARASOTA CENTER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9770
Mailing Address - Country:US
Mailing Address - Phone:941-302-8695
Mailing Address - Fax:
Practice Address - Street 1:98 SARASOTA CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9770
Practice Address - Country:US
Practice Address - Phone:941-302-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L06000094891332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies