MEDICARE: MR. JEFFREY LEE MPT

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	0946	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104000991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY LEE MPT

Provider Business Mailing Address
First Line	:	1005 N MAIN ST
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-1351
Country	:	US
Telephone Number	:	605-996-4552
Fax Number	:	605-996-0577

Provider Business Practice Location Address
First Line	:	1005 N MAIN ST
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-1351
Country	:	US
Telephone Number	:	605-996-4552
Fax Number	:	605-996-0577

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	01/14/2008

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Directions to “ MR. JEFFREY LEE MPT” Practice Location

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