Basic Information
| Provider Information | |||||||||
| NPI: | 1982698890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE-SIGLER | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8888 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049158888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012594260 | ||||||||
| FaxNumber: | 9012592785 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 PRIMACY PKWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017678662 | ||||||||
| FaxNumber: | 9017678666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 036076790 | IL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 39615 | TN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 39615 | 01 | TN | TENN LICENSE | OTHER | 4799 | 01 | IL | APM&R | OTHER | 30315 | 01 | TN | NASS | OTHER |