Provider Demographics
NPI:1093725780
Name:LEE, KAREN L (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
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 1:217 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2903
Mailing Address - Country:US
Mailing Address - Phone:509-684-5027
Mailing Address - Fax:509-684-6133
Practice Address - Street 1:217 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2903
Practice Address - Country:US
Practice Address - Phone:509-684-5027
Practice Address - Fax:509-684-6133
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005717225100000X
OR2363225100000X
IDPT8725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862080Medicare PIN