Provider Demographics
NPI:1457568073
Name:DUET-LEE, ELAINE MARCEL (PT)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARCEL
Last Name:DUET-LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:MARCEL
Other - Last Name:DUET-LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7333 BARLITE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1320
Mailing Address - Country:US
Mailing Address - Phone:210-924-3040
Mailing Address - Fax:210-924-3889
Practice Address - Street 1:7333 BARLITE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1320
Practice Address - Country:US
Practice Address - Phone:210-924-3040
Practice Address - Fax:210-924-3889
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058048225100000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX819T65OtherBLUE CROSS BLUE SHIELD
TX0370272-02Medicaid
TX1058048OtherPHYSICAL THERAPIST
TX0370272-02Medicaid