Provider Demographics
NPI:1770816019
Name:LEE, JOSEPHINE MAURICIO (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPHINE
Middle Name:MAURICIO
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 CAMERON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5657
Mailing Address - Country:US
Mailing Address - Phone:239-561-7365
Mailing Address - Fax:
Practice Address - Street 1:7460 LAKE BREEZE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8090
Practice Address - Country:US
Practice Address - Phone:239-481-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist