Provider Demographics
NPI:1649424771
Name:LEE, ROSANNA (PT)
Entity type:Individual
Prefix:MISS
First Name:ROSANNA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 71ST ST
Mailing Address - Street 2:APT. A2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1149
Mailing Address - Country:US
Mailing Address - Phone:917-699-2724
Mailing Address - Fax:
Practice Address - Street 1:138 71ST ST
Practice Address - Street 2:APT. A2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1149
Practice Address - Country:US
Practice Address - Phone:917-699-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01778-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics