Provider Demographics
NPI:1659344240
Name:PRICE, LEE ANN (ATC)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10875 E COUNTY ROAD 600N
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-8521
Mailing Address - Country:US
Mailing Address - Phone:217-549-0439
Mailing Address - Fax:
Practice Address - Street 1:600 LINCOLN AVE
Practice Address - Street 2:2220 LANTZ
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3011
Practice Address - Country:US
Practice Address - Phone:217-581-7615
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-00008922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer