Provider Demographics
NPI:1306316948
Name:LEE, CASEY KENT
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:KENT
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 S MATLACK ST APT 155
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4564
Mailing Address - Country:US
Mailing Address - Phone:408-218-6054
Mailing Address - Fax:
Practice Address - Street 1:890 S MATLACK ST APT 155
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4564
Practice Address - Country:US
Practice Address - Phone:408-218-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer