Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PTL0016357 | CO |
NPI | 1174178479 |
---|---|
Provider Name | Mckinley Lee |
First Address | Avon, CO 81620-5421 |
Second Address | Avon, CO 81620-5421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 05/08/2019 |