Provider Demographics
NPI:1093180994
Name:LEE, JERRY D JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:D
Last Name:LEE
Suffix:JR
Gender:M
Credentials:LMT
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Mailing Address - Street 1:2036 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-9720
Mailing Address - Country:US
Mailing Address - Phone:615-456-5400
Mailing Address - Fax:615-672-8857
Practice Address - Street 1:260 W MAIN ST
Practice Address - Street 2:207
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3347
Practice Address - Country:US
Practice Address - Phone:615-264-8515
Practice Address - Fax:615-264-8516
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN10644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist