=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629375894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEE ARTHUR NEWMAN III PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2011
-----------------------------------------------------
Last Update Date | 09/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 HIGHWAY 49 S SUITE 2
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39218-9425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-233-8844
-----------------------------------------------------
Fax | 769-251-1825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 HIGHWAY 49 S SUITE 2
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39218-9425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-233-8844
-----------------------------------------------------
Fax | 769-251-1825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT3359
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------