Provider Demographics
NPI:1629033022
Name:LEDFORD, LEE GERALD II (ATC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:GERALD
Last Name:LEDFORD
Suffix:II
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 WILD OAK CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4878
Mailing Address - Country:US
Mailing Address - Phone:502-550-4398
Mailing Address - Fax:888-266-0451
Practice Address - Street 1:11802 BRINLEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1089
Practice Address - Country:US
Practice Address - Phone:800-738-8045
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYAT586OtherKY BAORD OF MED LIC