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NPI Code Detail

MEDICARE: ERIN LEE DPT

MEDICARE: ERIN LEE DPT
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
1225100000XPhysical TherapistPTL0013982CO
2225100000XPhysical Therapist12673AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PTL0013982OTHERCOCO PT LICENSE
212673OTHERAZARIZONA STATE LICENSE

General Provider Information

NPI Number : 1861841306
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN LEE DPT
Provider Business Mailing Address
First Line : 1717 N KITTREDGE RD
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-1167
Country : US
Telephone Number : 928-606-4768
Fax Number :
Provider Business Practice Location Address
First Line : 2655 W CAREFREE HWY
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-8862
Country : US
Telephone Number : 623-434-4655
Fax Number : 623-434-4657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2016
Last Update Date : 12/01/2016

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