Provider Demographics
NPI:1417483611
Name:APPLEQUIST, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:APPLEQUIST
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 1:5926 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-9137
Mailing Address - Country:US
Mailing Address - Phone:610-217-6704
Mailing Address - Fax:
Practice Address - Street 1:5926 GLEN ROAD
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036
Practice Address - Country:US
Practice Address - Phone:610-217-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1282320225100000X
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist