Provider Demographics
NPI:1497913065
Name:LEE, MARYELLEN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:MARYELLEN
Other - Middle Name:
Other - Last Name:PIRRI-LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:62 BEEKMAN ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4026
Mailing Address - Country:US
Mailing Address - Phone:518-225-1440
Mailing Address - Fax:
Practice Address - Street 1:62 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4026
Practice Address - Country:US
Practice Address - Phone:518-225-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017010-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist