Provider Demographics
NPI:1619914637
Name:LEE, REBECCA MARIE-LEWIS (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARIE-LEWIS
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2965 E TARPON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9007
Mailing Address - Country:US
Mailing Address - Phone:208-287-9420
Mailing Address - Fax:888-322-2278
Practice Address - Street 1:4195 WESTBERG RD
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2950
Practice Address - Country:US
Practice Address - Phone:218-216-9921
Practice Address - Fax:218-520-0020
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4018225100000X
KY005922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist