MEDICARE: MR. LEE JAMES WHITEHEAD ATC,LAT

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	171W00000X	Contractor	AT2393	TX

General Provider Information

NPI Number	:	1730151606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE JAMES WHITEHEAD ATC,LAT

Provider Business Mailing Address
First Line	:	9231 RIDGE CROSS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-5086
Country	:	US
Telephone Number	:	210-682-2374
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 W FM 471
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4802
Country	:	US
Telephone Number	:	210-397-6068
Fax Number	:	210-688-6072

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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