Provider Demographics
NPI:1154355733
Name:LEE, TEKIA NICHELLE (MPT)
Entity type:Individual
Prefix:MS
First Name:TEKIA
Middle Name:NICHELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1511
Mailing Address - Country:US
Mailing Address - Phone:302-653-8389
Mailing Address - Fax:
Practice Address - Street 1:208 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1511
Practice Address - Country:US
Practice Address - Phone:302-653-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016469283X00000X
DEJ1-0002733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No283X00000XHospitalsRehabilitation Hospital