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NPI Code Detail

MEDICARE: MS. LEE XIONG PTA

MEDICARE: MS. LEE XIONG PTA
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 Assistant2445-19WI

General Provider Information

NPI Number : 1962074914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEE XIONG PTA
Provider Business Mailing Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number : 847-983-8750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2021
Last Update Date : 07/10/2021

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