MEDICARE: MRS. KATHERINE K. LEE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist		IL

General Provider Information

NPI Number	:	1336285436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE K. LEE DPT

Provider Business Mailing Address
First Line	:	672 PORTAGE CT
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-3417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RIVERSIDE PLZ
Second Line	:	SUITE 830
City	:	CHICAGO
State	:	IL
Zip	:	60606-5808
Country	:	US
Telephone Number	:	312-416-3804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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