Provider Demographics
NPI:1285345835
Name:LESAKO, MARK ANDREW (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:LESAKO
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2946
Mailing Address - Country:US
Mailing Address - Phone:724-249-2689
Mailing Address - Fax:
Practice Address - Street 1:60 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4812
Practice Address - Country:US
Practice Address - Phone:724-503-1001
Practice Address - Fax:724-250-3329
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001437A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer