Basic Information
| Provider Information | |||||||||
| NPI: | 1558702712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ARNOLD | ||||||||
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| Credential: | MS, ATC, CSCS, CES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 SANCTUARY LN | ||||||||
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| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605406364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307176873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1509 S MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606052802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3124310434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.