Provider Demographics
NPI:1922861285
Name:LEE, ANDREW JEFFERY (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JEFFERY
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HANNAS TER
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-8479
Mailing Address - Country:US
Mailing Address - Phone:540-520-8527
Mailing Address - Fax:
Practice Address - Street 1:707 E CERVANTES ST STE B216
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3286
Practice Address - Country:US
Practice Address - Phone:850-912-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216278225100000X
FLPT41187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist