Individual
MS. BRENDA LEE LESTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT/L
Contact information
Practice address
1755 RUSTIC TIMBERS LN APT 205, PRESCOTT, AZ 86303-6902
(330) 903-1018
Mailing address
50 HILLSIDE CT, HOWARD, OH 43028-8052
(330) 903-1018
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1361
OH
2255A2300X
Athletic Trainer
1033
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
CERTIFIED ATHLETIC TRAINER
AZ
Enumeration date
03/19/2014
Last updated
03/04/2018
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