Provider Demographics
NPI:1851044895
Name:LEE, ASIA LYNN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:ASIA
Middle Name:LYNN
Last Name:LEE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:ASIA
Other - Middle Name:LYNN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:565 CENTRAL AVE APT A305
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1451
Mailing Address - Country:US
Mailing Address - Phone:985-778-3994
Mailing Address - Fax:
Practice Address - Street 1:565 CENTRAL AVE APT A305
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1451
Practice Address - Country:US
Practice Address - Phone:985-778-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist