Provider Demographics
NPI:1255406492
Name:LEE, EDWARD P (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:LEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16610 HARBOUR TOWN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4084
Mailing Address - Country:US
Mailing Address - Phone:301-588-7778
Mailing Address - Fax:301-588-4147
Practice Address - Street 1:8380 COLESVILLE RD
Practice Address - Street 2:200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6255
Practice Address - Country:US
Practice Address - Phone:301-588-7778
Practice Address - Fax:301-588-4147
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC675386Medicare ID - Type Unspecified