MEDICARE: LISA 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	225200000X	Physical Therapy Assistant	2306606170	VA

General Provider Information

NPI Number	:	1619684032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LEE

Provider Business Mailing Address
First Line	:	2406 ATHERHOLT RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-2148
Country	:	US
Telephone Number	:	434-846-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 LORD DUNMORE DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5448
Country	:	US
Telephone Number	:	720-768-5203
Fax Number	:

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

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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Directions to “ LISA LEE ” Practice Location

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