MEDICARE: LEE FREDRICK PFEIFFER PT

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	1877	NE

General Provider Information

NPI Number	:	1609997246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE FREDRICK PFEIFFER PT

Provider Business Mailing Address
First Line	:	7540 NORTH 19TH AVE SUITE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:

Provider Business Practice Location Address
First Line	:	7540 N 19TH AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7967
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	03/21/2011

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