Provider Demographics
NPI:1528044138
Name:LEE, DAVID ALAN (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:LEE
Suffix:
Gender:M
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0003
Mailing Address - Country:US
Mailing Address - Phone:304-626-2340
Mailing Address - Fax:304-626-1583
Practice Address - Street 1:1520 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-8500
Practice Address - Country:US
Practice Address - Phone:304-626-2340
Practice Address - Fax:304-626-1583
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710276OtherBCBS
WV0156288000Medicaid
WV001710276OtherBCBS