Provider Demographics
NPI:1265250294
Name:TEMPLETON, LEE ANN
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:TEMPLETON
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 1:3800 N 6TH AVE APT 232
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3756
Mailing Address - Country:US
Mailing Address - Phone:520-203-5126
Mailing Address - Fax:
Practice Address - Street 1:3800 N 6TH AVE APT 232
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3756
Practice Address - Country:US
Practice Address - Phone:520-203-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist