Provider Demographics
NPI:1205563467
Name:LEE, BOBBY JEAN SANDERS (PT, DPT, LAT)
Entity type:Individual
Prefix:
First Name:BOBBY JEAN
Middle Name:SANDERS
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, DPT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 WILLOW RUN CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1518
Mailing Address - Country:US
Mailing Address - Phone:281-620-7102
Mailing Address - Fax:
Practice Address - Street 1:4801 WILLOW RUN CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1518
Practice Address - Country:US
Practice Address - Phone:281-620-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12442722251S0007X
TXAT89742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer