Provider Demographics
NPI:1841592136
Name:LEE, ANGELA S (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SW OCEAN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2561
Mailing Address - Country:US
Mailing Address - Phone:954-579-5619
Mailing Address - Fax:772-673-0523
Practice Address - Street 1:1615 SW OCEAN COVE AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2561
Practice Address - Country:US
Practice Address - Phone:954-579-5619
Practice Address - Fax:772-673-0523
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist