Provider Demographics
NPI:1326059296
Name:BROWNELL, LEE ALLEN
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:ALLEN
Last Name:BROWNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6015
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:559-713-6809
Practice Address - Street 1:1653 N SCHNOOR AVE STE 107
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3613
Practice Address - Country:US
Practice Address - Phone:559-831-2050
Practice Address - Fax:559-660-5341
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8920225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770332486OtherTIN
CAZZZ21079ZMedicare ID - Type Unspecified