MEDICARE: TAYLOR LEE

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	PT030835	PA

General Provider Information

NPI Number	:	1366187155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LEE

Provider Business Mailing Address
First Line	:	1875 SANTA RITA RD
Second Line	:
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5226 N NORTHWEST HWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4620
Country	:	US
Telephone Number	:	708-669-2493
Fax Number	:

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

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	01/12/2023

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Directions to “ TAYLOR LEE ” Practice Location

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