Provider Demographics
NPI:1700433877
Name:LESSARD, NATHAN J (DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:LESSARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32246 CLINTON KEITH RD
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7320
Mailing Address - Country:US
Mailing Address - Phone:951-677-7221
Mailing Address - Fax:951-677-7331
Practice Address - Street 1:32246 CLINTON KEITH RD
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7320
Practice Address - Country:US
Practice Address - Phone:951-677-7221
Practice Address - Fax:951-677-7331
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03217225100000X
NCP21108225100000X
CA305951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist