Provider Demographics
NPI:1154299329
Name:LEE, SAMUEL JR (RRT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LEE
Suffix:JR
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 N COUNTY ROAD 53
Mailing Address - Street 2:
Mailing Address - City:MAYO
Mailing Address - State:FL
Mailing Address - Zip Code:32066-2629
Mailing Address - Country:US
Mailing Address - Phone:352-222-4748
Mailing Address - Fax:
Practice Address - Street 1:6480 N COUNTY ROAD 53
Practice Address - Street 2:
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066-2629
Practice Address - Country:US
Practice Address - Phone:352-222-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT14724227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered