Provider Demographics
NPI:1588841555
Name:LEE, KATHERINE JEANNE (MSPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 BARLOW ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4721
Mailing Address - Country:US
Mailing Address - Phone:231-941-3100
Mailing Address - Fax:231-922-0382
Practice Address - Street 1:1650 BARLOW ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4721
Practice Address - Country:US
Practice Address - Phone:231-941-3100
Practice Address - Fax:231-922-0382
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist