Individual
MISS LESIA J NULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4834 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1340
(304) 768-6106
(304) 720-2049
Mailing address
29 LAKE SHORE DR, CROSS LANES, WV 25313-3505
(304) 552-5097
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20082507
WV
Other
Enumeration date
02/16/2009
Last updated
02/16/2009
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