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NPI Code Detail

MEDICARE: MOLLY ELIZABETH LEE PT

MEDICARE: MOLLY ELIZABETH LEE PT
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
1225100000XPhysical Therapist6740MN

General Provider Information

NPI Number : 1982872537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY ELIZABETH LEE PT
Provider Business Mailing Address
First Line : 12400 PORTLAND AVE STE 140
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6805
Country : US
Telephone Number : 952-428-0400
Fax Number : 612-863-5698
Provider Business Practice Location Address
First Line : 12400 PORTLAND AVE STE 140
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6805
Country : US
Telephone Number : 952-428-0400
Fax Number : 952-428-0417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2008
Last Update Date : 04/08/2020

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