Provider Demographics
NPI:1083909931
Name:LEE, PAMELA J (MPT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LIONS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9575
Mailing Address - Country:US
Mailing Address - Phone:319-665-2111
Mailing Address - Fax:319-665-2114
Practice Address - Street 1:3 LIONS DR
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9575
Practice Address - Country:US
Practice Address - Phone:319-665-2111
Practice Address - Fax:319-665-2114
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0322222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283002Medicaid
IAI8623Medicare UPIN