Provider Demographics
NPI:1629082805
Name:LEE, JAMES RICHARD
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E GREENBRIER
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2638
Mailing Address - Country:US
Mailing Address - Phone:501-778-7986
Mailing Address - Fax:
Practice Address - Street 1:2113 WATTS RD.
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-778-4960
Practice Address - Fax:501-778-4968
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist