Provider Demographics
NPI:1386169282
Name:LEE, STEPHANIE (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RICHMOND SQ
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:204 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5473
Practice Address - Country:US
Practice Address - Phone:781-772-2406
Practice Address - Fax:844-912-8608
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist