Provider Demographics
NPI:1023197381
Name:LEE, CATHY ANN (CMT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VILLAGE GREEN PKWY
Mailing Address - Street 2:STE 18
Mailing Address - City:BRANDENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-792-7647
Mailing Address - Fax:941-761-1187
Practice Address - Street 1:501 VILLAGE GREEN PKWY
Practice Address - Street 2:STE 18
Practice Address - City:BRANDENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-792-7647
Practice Address - Fax:941-761-1187
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist