Healthcare Provider Details

I. General information

NPI: 1679168462
Provider Name (Legal Business Name): JULIE LEE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 01/19/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W MAIN ST
PLAINFIELD IN
46168-1117
US

IV. Provider business mailing address

207 W MAIN ST
PLAINFIELD IN
46168-1117
US

V. Phone/Fax

Practice location:
  • Phone: 317-405-4519
  • Fax:
Mailing address:
  • Phone: 317-405-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIE MARIE LEE
Title or Position: OWNER
Credential: PT, DPT
Phone: 317-409-4519