Provider Demographics
NPI:1528278926
Name:BENTLEY, LESTA A (LMP)
Entity type:Individual
Prefix:MRS
First Name:LESTA
Middle Name:A
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:LESTA
Other - Middle Name:A
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:1233 LAWRENCE ST
Mailing Address - Street 2:#201
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6554
Mailing Address - Country:US
Mailing Address - Phone:360-385-2107
Mailing Address - Fax:
Practice Address - Street 1:1233 LAWRENCE ST
Practice Address - Street 2:#201
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6554
Practice Address - Country:US
Practice Address - Phone:360-385-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist