Provider Demographics
NPI:1912020611
Name:LEE, LANDA (NCMT)
Entity Type:Individual
Prefix:MS
First Name:LANDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 NIAGARA DRIVE
Mailing Address - Street 2:#15
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-498-9011
Mailing Address - Fax:
Practice Address - Street 1:1190 NIAGARA DRIVE
Practice Address - Street 2:#15
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-498-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27993000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist