=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396624540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELANEY J LEE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2025
-----------------------------------------------------
Last Update Date | 09/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 JOHN B WHITE SR BLVD STE 1B
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29306-3996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-587-6205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1308 SIMMONS RIDGE LN
-----------------------------------------------------
City | MOORE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29369-7702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-800-0819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | PTA.6854
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------