Provider Demographics
NPI:1063707404
Name:LEE, ANGELINA KAE (PT)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:KAE
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JAKINS ST
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:TASMANIA
Mailing Address - Zip Code:7467
Mailing Address - Country:AU
Mailing Address - Phone:61036-471-2037
Mailing Address - Fax:
Practice Address - Street 1:641 W WILLOUGHBY AVE
Practice Address - Street 2:STE 206
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1773
Practice Address - Country:US
Practice Address - Phone:907-586-5951
Practice Address - Fax:907-586-8017
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist