Provider Demographics
NPI:1275607442
Name:LEE, KIMBERLY K (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:WILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0922
Mailing Address - Country:US
Mailing Address - Phone:866-309-5567
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:5828 PEARL DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-8116
Practice Address - Country:US
Practice Address - Phone:812-437-1420
Practice Address - Fax:812-437-1425
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4927225100000X
IN05002357A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist