Provider Demographics
NPI:1770850901
Name:LEE, KATRINA L (PT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:L
Other - Last Name:VANALSTYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-1244
Mailing Address - Country:US
Mailing Address - Phone:518-622-9200
Mailing Address - Fax:518-622-9945
Practice Address - Street 1:4383 ROUTE 23
Practice Address - Street 2:SUITE 102
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2680
Practice Address - Country:US
Practice Address - Phone:518-622-9200
Practice Address - Fax:518-622-9945
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400060160Medicare PIN