Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 20118 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 20118 | MD |
NPI | 1063691954 |
---|---|
Provider Name | Jenny Lee |
First Address | Bethesda, MD 20814-2224 |
Second Address | Columbia, MD 21046-2269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 11/09/2020 |