Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101100848 | VA |
NPI | 1053460014 |
---|---|
Provider Name | Laura W. Lee |
First Address | Charlottesville, VA 22903-2981 |
Second Address | Charlottesville, VA 22903-2981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6802923 | (05) | VA |
G80427 | (02) | VA |