MEDICARE: JOHNNY J LEE-ON 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	1070712	TX

General Provider Information

NPI Number	:	1225224538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY J LEE-ON RPT

Provider Business Mailing Address
First Line	:	3302 MEADWAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 KATY FREEWAY, SUITE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2204
Country	:	US
Telephone Number	:	713-695-7800
Fax Number	:	713-695-7806

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	10/17/2012

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