Provider Demographics
NPI:1689867210
Name:LEE, KRISTY M (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8934 HILL DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2928
Mailing Address - Country:US
Mailing Address - Phone:225-293-2696
Mailing Address - Fax:
Practice Address - Street 1:7731 PERKINS RD
Practice Address - Street 2:STE. 155
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1078
Practice Address - Country:US
Practice Address - Phone:225-766-3031
Practice Address - Fax:225-767-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist