Healthcare Provider Details

I. General information

NPI: 1477839686
Provider Name (Legal Business Name): KRISTEN MCCOY LEE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 WRIGHTSVILLE AVE STE 120
WILMINGTON NC
28403-6256
US

IV. Provider business mailing address

1011 PORTERS NECK RD
WILMINGTON NC
28411-9196
US

V. Phone/Fax

Practice location:
  • Phone: 910-679-8385
  • Fax:
Mailing address:
  • Phone: 910-566-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP2763
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2763
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: