Provider Demographics
NPI:1437353398
Name:ROONEY, LEE RADAZA (RRT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:RADAZA
Last Name:ROONEY
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2906 SEDGEWICK DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3332
Mailing Address - Country:US
Mailing Address - Phone:434-455-2933
Mailing Address - Fax:434-384-3445
Practice Address - Street 1:2906 SEDGEWICK DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3332
Practice Address - Country:US
Practice Address - Phone:434-455-2933
Practice Address - Fax:434-384-3445
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01170052012279G1100X
VA21620332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437353398Medicaid