Provider Demographics
NPI:1992083570
Name:LEE, KAILEEN (DPT)
Entity type:Individual
Prefix:
First Name:KAILEEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9194 RED BRANCH RD
Mailing Address - Street 2:STE J
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2005
Mailing Address - Country:US
Mailing Address - Phone:240-640-6226
Mailing Address - Fax:
Practice Address - Street 1:9171 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3944
Practice Address - Country:US
Practice Address - Phone:410-480-3705
Practice Address - Fax:410-480-3707
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD251352251X0800X
MD23677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic