Provider Demographics
NPI:1750107009
Name:LEE, ELIZABETH ANN (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14827 STATE HWY 3
Mailing Address - Street 2:
Mailing Address - City:BROADVEIW
Mailing Address - State:MT
Mailing Address - Zip Code:59015
Mailing Address - Country:US
Mailing Address - Phone:307-272-3960
Mailing Address - Fax:
Practice Address - Street 1:14827 STATE HWY 3
Practice Address - Street 2:
Practice Address - City:BROADVEIW
Practice Address - State:MT
Practice Address - Zip Code:59015
Practice Address - Country:US
Practice Address - Phone:307-272-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-4143225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist