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NPI Code Detail

MEDICARE: DEBBRA LEE

MEDICARE: DEBBRA 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
1225200000XPhysical Therapy Assistant2024420TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720560204
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBBRA LEE
Provider Business Mailing Address
First Line : 4825 WELLESLEY AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-6148
Country : US
Telephone Number : 817-732-6608
Fax Number : 817-377-4714
Provider Business Practice Location Address
First Line : 4825 WELLESLEY AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-6148
Country : US
Telephone Number : 817-732-6608
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2018
Last Update Date : 08/31/2018

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Directions to “ DEBBRA LEE ” Practice Location

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