Provider Demographics
NPI:1598086860
Name:LEE, TERESA (LMT/HWC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT/HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7738 BRISBANE BND
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1965
Mailing Address - Country:US
Mailing Address - Phone:210-763-3165
Mailing Address - Fax:855-398-8080
Practice Address - Street 1:1846 N LOOP 1604 W STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4541
Practice Address - Country:US
Practice Address - Phone:210-802-2597
Practice Address - Fax:855-398-8080
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174H00000X
TXMT037318225700000X
ALA-3624516171400000X
TXMT037318/MI2169225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty