Basic Information
| Provider Information | |||||||||
| NPI: | 1629082029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 CINEMA BLVD | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784666677 | ||||||||
| FaxNumber: | 9784661133 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 CINEMA BLVD | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784666677 | ||||||||
| FaxNumber: | 9784661133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 12/31/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15530 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y68249 | 01 | BCBS | OTHER | 468308 | 01 | TUFTS | OTHER |