Provider Demographics
NPI:1275608275
Name:LEE, LAURI B (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
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 1:8673 15TH WAY N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2815
Mailing Address - Country:US
Mailing Address - Phone:727-423-0060
Mailing Address - Fax:727-369-8803
Practice Address - Street 1:8673 15TH WAY N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2815
Practice Address - Country:US
Practice Address - Phone:727-423-0060
Practice Address - Fax:727-369-8803
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 131302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885815200Medicaid