Provider Demographics
NPI:1427894674
Name:LESTER, CATRINA ANTOINETTE (DPT)
Entity type:Individual
Prefix:
First Name:CATRINA
Middle Name:ANTOINETTE
Last Name:LESTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7159 HARCOURT XING
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5841
Mailing Address - Country:US
Mailing Address - Phone:980-333-1095
Mailing Address - Fax:
Practice Address - Street 1:2300 GALLBERRY LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0161
Practice Address - Country:US
Practice Address - Phone:704-649-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12460225100000X
NCCP033249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist