Provider Demographics
NPI:1801461538
Name:LESSERT, FAITH OLIVIA (PTA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:OLIVIA
Last Name:LESSERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:OLIVIA
Other - Last Name:ASHFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4708 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-7016
Mailing Address - Country:US
Mailing Address - Phone:580-789-1007
Mailing Address - Fax:
Practice Address - Street 1:101 N POST RD STE A
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3605
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3383225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant