MEDICARE: MURIEL JOAN LEE P. T.

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	2775252401	UT
2	2251C2600X	Cardiopulmonary Physical Therapist	2775252401	UT
3	2251G0304X	Geriatric Physical Therapist	2775252401	UT
4	2251H1200X	Hand Physical Therapist	2775252401	UT
5	2251N0400X	Neurology Physical Therapist	2775252401	UT
6	2251P0200X	Pediatric Physical Therapist	2775252401	UT
7	2251S0007X	Sports Physical Therapist	2775252401	UT
8	2251X0800X	Orthopedic Physical Therapist	2775252401	UT

General Provider Information

NPI Number	:	1053755769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MURIEL JOAN LEE P. T.

Provider Business Mailing Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0257
Fax Number	:	801-251-0259

Provider Business Practice Location Address
First Line	:	4568 S HIGHLAND DR STE 180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4236
Country	:	US
Telephone Number	:	801-251-0257
Fax Number	:	801-251-0259

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

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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