Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 22499 | MA |
N | 2251S0007X | Physical Therapist - Sports | 22499 | MA |
NPI | 1417401159 |
---|---|
Provider Name | Erica Lee |
First Address | Randolph, MA 02368-4633 |
Second Address | Hingham, MA 02043-1611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2016 |
Last Update Date | 04/11/2019 |