Healthcare Provider Details

I. General information

NPI: 1992083570
Provider Name (Legal Business Name): KAILEEN LEE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9171 BALTIMORE NATIONAL PIKE SUITE 120
ELLICOTT CITY MD
21042-3944
US

IV. Provider business mailing address

9194 RED BRANCH RD STE J
COLUMBIA MD
21045-2005
US

V. Phone/Fax

Practice location:
  • Phone: 410-480-3705
  • Fax: 410-480-3707
Mailing address:
  • Phone: 240-640-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23677
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number25135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: