Provider Demographics
NPI:1205830973
Name:LEE PHYSICAL THERAPY WELLNESS LLC
Entity Type:Organization
Organization Name:LEE PHYSICAL THERAPY WELLNESS LLC
Other - Org Name:LEE PHYSICAL THERAPY & WELLNESS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/SINGLE MEMBER/PHYSICAL THERAP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:518-622-9200
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:348 MAIN STREET
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413
Mailing Address - Country:US
Mailing Address - Phone:518-622-9200
Mailing Address - Fax:518-622-9945
Practice Address - Street 1:348 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413
Practice Address - Country:US
Practice Address - Phone:518-622-9200
Practice Address - Fax:518-622-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02369877Medicaid
NYQ0WKY1Medicare PIN