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General NPI Number Information
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NPI Number | 1982804829
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Entity Type | Individual
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Provider Name | ROBERT LEE
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 945 COUNTY ROAD 77
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City | BISHOP
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State | TX
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Zip | 78343-5099
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Country | US
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Telephone | 361-522-7989
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Fax | 361-584-2499
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Provider Business Mailing Address
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Address Line | PO BOX 279
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City | BISHOP
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State | TX
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Zip | 78343-0279
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Country | US
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Telephone | 360-522-7989
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Fax | 361-584-2499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1078962
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License Number State | TX
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