Provider Demographics
NPI:1861841306
Name:LEE, ERIN (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N KITTREDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1167
Mailing Address - Country:US
Mailing Address - Phone:928-606-4768
Mailing Address - Fax:
Practice Address - Street 1:2655 W CAREFREE HWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8862
Practice Address - Country:US
Practice Address - Phone:623-434-4655
Practice Address - Fax:623-434-4657
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0013982225100000X
AZ12673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL0013982OtherCO PT LICENSE
AZ12673OtherARIZONA STATE LICENSE