Provider Demographics
NPI:1104938307
Name:LEE, ROSA M (PT)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:LEE
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:
Practice Address - Street 1:9085 SW 87TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2309
Practice Address - Country:US
Practice Address - Phone:305-412-3336
Practice Address - Fax:855-882-7612
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30720225700000X
FLPT17999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887060800Medicaid
FL887060800Medicaid