Provider Demographics
NPI:1952606865
Name:LEE, KIM H (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:H
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 1:3025 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:UNIT C-2A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8447
Mailing Address - Country:US
Mailing Address - Phone:843-608-3100
Mailing Address - Fax:
Practice Address - Street 1:3025 ASHLEY PHOSPHATE RD
Practice Address - Street 2:UNIT C-2A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8447
Practice Address - Country:US
Practice Address - Phone:843-608-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS 5379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist