Provider Demographics
NPI:1154097517
Name:LEE, SHERIDAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHERIDAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 NW 28TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5823
Mailing Address - Country:US
Mailing Address - Phone:352-792-4312
Mailing Address - Fax:
Practice Address - Street 1:2001 NE 48TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4517
Practice Address - Country:US
Practice Address - Phone:352-792-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist