Provider Demographics
NPI:1679720874
Name:LEE, ANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:765 W TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2432
Mailing Address - Country:US
Mailing Address - Phone:636-262-3036
Mailing Address - Fax:636-379-9023
Practice Address - Street 1:765 W TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2432
Practice Address - Country:US
Practice Address - Phone:636-262-3036
Practice Address - Fax:636-379-9023
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008789172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1679720874OtherBLUE CROSS BLUE SHIELD