Provider Demographics
NPI:1013121227
Name:LESTER, LISA G (CRT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:LESTER
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 DELESPINE RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7025 N WICKHAM RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7534
Practice Address - Country:US
Practice Address - Phone:321-242-1046
Practice Address - Fax:321-253-3119
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT12272227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified