Provider Demographics
NPI:1447686035
Name:MINISH, LESTER ROSCOE JR (PTA)
Entity type:Individual
Prefix:MR
First Name:LESTER
Middle Name:ROSCOE
Last Name:MINISH
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:708 STACY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5750
Mailing Address - Country:US
Mailing Address - Phone:828-808-8016
Mailing Address - Fax:
Practice Address - Street 1:617 LAUREL LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-7401
Practice Address - Country:US
Practice Address - Phone:828-894-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5136225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant