Provider Demographics
NPI:1417662529
Name:MEHEULA, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:MEHEULA
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 1:440 S 1100 E APT 301
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2051
Mailing Address - Country:US
Mailing Address - Phone:808-783-8022
Mailing Address - Fax:
Practice Address - Street 1:440 S 1100 E APT 301
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2051
Practice Address - Country:US
Practice Address - Phone:808-783-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer