Provider Demographics
NPI:1316909427
Name:CORTEZ, LEE JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:JOSEPH
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3785
Mailing Address - Country:US
Mailing Address - Phone:504-214-8727
Mailing Address - Fax:
Practice Address - Street 1:103 ESTATE DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3785
Practice Address - Country:US
Practice Address - Phone:504-214-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA431315504COtherBLUECROSS
LA5D244Medicare ID - Type UnspecifiedGROUP NUMBER