MEDICARE: ERIC LEE RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT27708	CA
2	225100000X	Physical Therapist	22151	MD

General Provider Information

NPI Number	:	1043244197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC LEE RPT

Provider Business Mailing Address
First Line	:	7678 MIDTOWN RD
Second Line	:
City	:	FULTON
State	:	MD
Zip	:	20759-2513
Country	:	US
Telephone Number	:	240-888-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	9123 GAITHER RD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1451
Country	:	US
Telephone Number	:	909-496-3468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/29/2021

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