Provider Demographics
NPI:1164416913
Name:LEE, MICHAEL JEFFREY (PT DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:LEE
Suffix:
Gender:M
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:PO BOX 35052
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-5052
Mailing Address - Country:US
Mailing Address - Phone:520-219-5825
Mailing Address - Fax:520-219-5827
Practice Address - Street 1:6970 N ORACLE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4237
Practice Address - Country:US
Practice Address - Phone:520-219-5825
Practice Address - Fax:520-219-5827
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77697Medicare ID - Type Unspecified
P12510Medicare UPIN