Provider Demographics
NPI:1710471933
Name:LEE, CARLY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8281
Mailing Address - Country:US
Mailing Address - Phone:649-183-0848
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:3445 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-8281
Practice Address - Country:US
Practice Address - Phone:649-183-0848
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist