Provider Demographics
NPI:1770604894
Name:LEE, DOREEN (LPT)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MAYAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8923
Mailing Address - Country:US
Mailing Address - Phone:270-300-2121
Mailing Address - Fax:270-765-8603
Practice Address - Street 1:336 MAYAPPLE LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8923
Practice Address - Country:US
Practice Address - Phone:270-300-2121
Practice Address - Fax:270-765-8603
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist