Provider Demographics
NPI:1811934433
Name:LEE THERAPIST GROUP, LLC
Entity type:Organization
Organization Name:LEE THERAPIST GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALL
Authorized Official - Last Name:HILLYER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:239-209-1198
Mailing Address - Street 1:700 EL DORADO PKWY W
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7232
Mailing Address - Country:US
Mailing Address - Phone:239-209-1198
Mailing Address - Fax:239-945-5441
Practice Address - Street 1:700 EL DORADO PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-7232
Practice Address - Country:US
Practice Address - Phone:239-209-1198
Practice Address - Fax:239-945-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9778Medicare ID - Type UnspecifiedPT PRIVATE PRACTICE GROUP