Provider Demographics
NPI:1477869097
Name:LEE, JENNIFER BRIANNE (PT, DPT, FAFS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BRIANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, DPT, FAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17440 N. 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053
Mailing Address - Country:US
Mailing Address - Phone:573-631-9953
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:16165 N. 83RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:573-631-9953
Practice Address - Fax:623-935-0934
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist