Basic Information
| Provider Information | |||||||||
| NPI: | 1255585196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | LORINDA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6171 HUNTLEY RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148400558 | ||||||||
| FaxNumber: | 6148409310 | ||||||||
| Practice Location | |||||||||
| Address1: | 6171 HUNTLEY RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148400558 | ||||||||
| FaxNumber: | 6148409310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 11/05/2008 | ||||||||
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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 | PT005904 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2642626 | 05 | OH | MEDICAID |