Provider Demographics
NPI:1831774538
Name:R LEE PT
Entity type:Organization
Organization Name:R LEE PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-902-8230
Mailing Address - Street 1:312 WEEKS AVE
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2045
Mailing Address - Country:US
Mailing Address - Phone:631-902-8230
Mailing Address - Fax:
Practice Address - Street 1:312 WEEKS AVE
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2045
Practice Address - Country:US
Practice Address - Phone:631-902-8230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty