Provider Demographics
NPI:1992015671
Name:GARNER, LEE WILLIAM (PTA)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:WILLIAM
Last Name:GARNER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MERIDIAN CROSSINGS
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4584
Mailing Address - Country:US
Mailing Address - Phone:517-347-2495
Mailing Address - Fax:517-347-3540
Practice Address - Street 1:3536 MERIDIAN CROSSINGS
Practice Address - Street 2:SUITE 240
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4584
Practice Address - Country:US
Practice Address - Phone:517-347-2495
Practice Address - Fax:517-347-3540
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000845225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5502000845OtherLICENSE