Provider Demographics
NPI:1891102307
Name:LEE, JESSICA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 LAKE SPANGENBERG RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-5005
Mailing Address - Country:US
Mailing Address - Phone:570-396-1812
Mailing Address - Fax:
Practice Address - Street 1:256 SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3322
Practice Address - Country:US
Practice Address - Phone:570-283-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist