Provider Demographics
NPI:1760631584
Name:GITTNER, LEE HIXON
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:HIXON
Last Name:GITTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 HALIFAX DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-3712
Mailing Address - Country:US
Mailing Address - Phone:386-451-2773
Mailing Address - Fax:
Practice Address - Street 1:1934 HALIFAX DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-3712
Practice Address - Country:US
Practice Address - Phone:386-451-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist