Provider Demographics
NPI:1316042484
Name:WHITTED, LEE MARY (LMT)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:MARY
Last Name:WHITTED
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5537 SW 37TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5131
Mailing Address - Country:US
Mailing Address - Phone:352-378-2862
Mailing Address - Fax:352-371-1721
Practice Address - Street 1:2720 NW 6TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2994
Practice Address - Country:US
Practice Address - Phone:352-371-1721
Practice Address - Fax:352-371-1721
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA18421225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA18421Medicare UPIN