| Doctor Name: | MISS LESIA J NULL |
| NPI Number: | 1902045958 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMT |
| License Number: | 20082507 |
| Business Practice Address: | 4834 Maccorkle Ave Sw South Charleston, WV - 253091340 |
| Business Phone Number: | 3047686106 |
| Business Fax Number: | 3047202049 |
| Mailing Address: | 29 Lake Shore Dr, CROSS LANES |
| State: | WV |
| Postal Code: | 253133505 |
| Phone Number: | 3045525097 |
| Fax Number: | |
| NPI Enumeration Date: | 02/16/2009 |
| NPI Last Update Date: | 02/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 20082507 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |