MEDICARE: STEPHANIE LEE LMT,CMMP

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	225700000X	Massage Therapist	MT009398	GA

General Provider Information

NPI Number	:	1437816279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LEE LMT,CMMP

Provider Business Mailing Address
First Line	:	1725 STILLWOOD FOREST DR SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-5633
Country	:	US
Telephone Number	:	678-425-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 STILLWOOD FOREST DR SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-5633
Country	:	US
Telephone Number	:	678-425-7874
Fax Number	:

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

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

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