Provider Demographics
NPI:1982804829
Name:LEE, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:TX
Mailing Address - Zip Code:78343-0279
Mailing Address - Country:US
Mailing Address - Phone:360-522-7989
Mailing Address - Fax:361-584-2499
Practice Address - Street 1:945 COUNTY ROAD 77
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:TX
Practice Address - Zip Code:78343-5099
Practice Address - Country:US
Practice Address - Phone:361-522-7989
Practice Address - Fax:361-584-2499
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10789622251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics