MEDICARE: AMY ELIZABETH 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	PT4022	OK

General Provider Information

NPI Number	:	1609079383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELIZABETH LEE MPT

Provider Business Mailing Address
First Line	:	2408 OLD CREEK RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-1537
Country	:	US
Telephone Number	:	405-822-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 S 29TH ST
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-2501
Country	:	US
Telephone Number	:	405-224-3100
Fax Number	:	405-224-3102

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/22/2021

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