Provider Demographics
NPI:1174858310
Name:LEE, JASON DONALD (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DONALD
Last Name:LEE
Suffix:
Gender:M
Credentials:PT
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 14039
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0039
Mailing Address - Country:US
Mailing Address - Phone:706-863-9797
Mailing Address - Fax:706-860-7686
Practice Address - Street 1:3650 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1867
Practice Address - Country:US
Practice Address - Phone:706-863-9797
Practice Address - Fax:706-860-7686
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0079682251X0800X, 225100000X
SCPT.9934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic