Provider Demographics
NPI:1477053791
Name:LEE, STORMIE LEE (PT)
Entity Type:Individual
Prefix:DR
First Name:STORMIE
Middle Name:LEE
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STORMIE
Other - Middle Name:LEE
Other - Last Name:BETHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6033 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1042
Mailing Address - Country:US
Mailing Address - Phone:817-483-1746
Mailing Address - Fax:817-483-5874
Practice Address - Street 1:6033 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1042
Practice Address - Country:US
Practice Address - Phone:817-483-1746
Practice Address - Fax:817-483-5874
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1302122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1302122OtherTEXAS BOARD OF PT EXAMINERS