Provider Demographics
NPI:1669501870
Name:VORKINK, LEE S (PT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:S
Last Name:VORKINK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565-1482
Mailing Address - Country:US
Mailing Address - Phone:660-947-3361
Mailing Address - Fax:660-947-2912
Practice Address - Street 1:803 S 20TH ST
Practice Address - Street 2:PUTNAM COUNTY R-I SCHOOL DISTRICT
Practice Address - City:UNIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:63565-1482
Practice Address - Country:US
Practice Address - Phone:660-947-3361
Practice Address - Fax:660-947-2912
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO484767603Medicaid