Provider Demographics
NPI:1720225451
Name:LEE, DEBRA A (ATC/L)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7807
Mailing Address - Country:US
Mailing Address - Phone:850-932-6382
Mailing Address - Fax:850-932-9215
Practice Address - Street 1:1000 COLLEGE BLVD
Practice Address - Street 2:ATHLETIC DEPARTMENT - PJC
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8910
Practice Address - Country:US
Practice Address - Phone:850-484-1305
Practice Address - Fax:850-484-1876
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer