Provider Demographics
NPI:1215636360
Name:LESTER, TARA (LMT,)
Entity type:Individual
Prefix:
First Name:TARA
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 1:13453 N MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2273
Mailing Address - Country:US
Mailing Address - Phone:904-955-2706
Mailing Address - Fax:
Practice Address - Street 1:13453 N MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2273
Practice Address - Country:US
Practice Address - Phone:904-955-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA99759OtherMASSAGE THERAPIST LICENSE