Provider Demographics
NPI:1558025841
Name:LEE, JONA (PT)
Entity Type:Individual
Prefix:
First Name:JONA
Middle Name:
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 1:1810 MIDDAY DR
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-9252
Mailing Address - Country:US
Mailing Address - Phone:224-645-0223
Mailing Address - Fax:
Practice Address - Street 1:1810 MIDDAY DR
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-9252
Practice Address - Country:US
Practice Address - Phone:224-645-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist