Provider Demographics
NPI:1326375387
Name:LEE, ANDREW K (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:425 OLD NEWMAN ROAD, SUITE #401
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:469-796-2100
Mailing Address - Fax:
Practice Address - Street 1:425 OLD NEWMAN RD STE 401
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4772
Practice Address - Country:US
Practice Address - Phone:469-796-2100
Practice Address - Fax:469-796-2101
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004056-1171100000X
NJ25MZ00068000171100000X
NJ40QA01473100225100000X
TX1252615225100000X
TXAC01598171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist