Provider Demographics
NPI:1275065252
Name:LEE PHYSICAL THERAPY AND REHAB INC
Entity Type:Organization
Organization Name:LEE PHYSICAL THERAPY AND REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:IL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:470-395-8988
Mailing Address - Street 1:3473 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4610
Mailing Address - Country:US
Mailing Address - Phone:470-395-8988
Mailing Address - Fax:470-246-5090
Practice Address - Street 1:3473 OLD NORCROSS RD
Practice Address - Street 2:SUITE 306
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4610
Practice Address - Country:US
Practice Address - Phone:470-395-8988
Practice Address - Fax:470-246-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT012403OtherGEORGE STATE BOARD OF PHYSICAL THERAPY