Provider Demographics
NPI:1467433771
Name:LEE, KENDRA MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:MICHELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SMELTER AVE NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1963
Mailing Address - Country:US
Mailing Address - Phone:406-727-2826
Mailing Address - Fax:406-727-3522
Practice Address - Street 1:115 SMELTER AVE NE
Practice Address - Street 2:SUITE 104
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1963
Practice Address - Country:US
Practice Address - Phone:406-727-2826
Practice Address - Fax:406-727-3522
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1558PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000061968OtherBC
MTP00052172OtherRAILROAD MDCR
MT3400187Medicaid
MT3400187Medicaid