Provider Demographics
NPI:1013728948
Name:ROUNTREE, LEE ANNE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ANNE
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MATTIES WAY
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3420
Mailing Address - Country:US
Mailing Address - Phone:850-974-7534
Mailing Address - Fax:
Practice Address - Street 1:4579 E HIGHWAY 20 STE 210
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9810
Practice Address - Country:US
Practice Address - Phone:850-974-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist