Healthcare Provider Details

I. General information

NPI: 1023921525
Provider Name (Legal Business Name): LEE T WHITESELL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5307 CARAWAY LN
CEDAR FALLS IA
50613-8172
US

IV. Provider business mailing address

5307 CARAWAY LN
CEDAR FALLS IA
50613-8172
US

V. Phone/Fax

Practice location:
  • Phone: 319-859-9341
  • Fax:
Mailing address:
  • Phone: 319-859-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number089989
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: