Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1114483914 |
---|---|
Provider Name | Kayla Marie Lee |
First Address | Colorado Springs, CO 80920-5338 |
Second Address | Colorado Springs, CO 80920-7815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2019 |
Last Update Date | 22/07/2021 |