Provider Demographics
NPI:1598948291
Name:LEE, MARCIA (LMT/CMT)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT/CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 J W FOSTER BLVD
Mailing Address - Street 2:FITNESS CENTER
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1099
Mailing Address - Country:US
Mailing Address - Phone:781-401-5252
Mailing Address - Fax:508-437-5555
Practice Address - Street 1:1895 J W FOSTER BLVD
Practice Address - Street 2:FITNESS CENTER
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1099
Practice Address - Country:US
Practice Address - Phone:781-401-5252
Practice Address - Fax:508-437-5555
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009572-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist