Basic Information
| Provider Information | |||||||||
| NPI: | 1609106061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11901 PLEASANT RIDGE RD | ||||||||
| Address2: | APT 724 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722232399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705350010 | ||||||||
| FaxNumber: | 8705351116 | ||||||||
| Practice Location | |||||||||
| Address1: | 11901 PLEASANT RIDGE RD | ||||||||
| Address2: | APT 724 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722232399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705350010 | ||||||||
| FaxNumber: | 8705351116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2010 | ||||||||
| LastUpdateDate: | 01/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3208 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | RXBAN 2653733 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER |