Provider Demographics
NPI: | 1053755769 |
---|---|
Name: | LEE, MURIEL JOAN (P T) |
Entity type: | Individual |
Prefix: | |
First Name: | MURIEL |
Middle Name: | JOAN |
Last Name: | LEE |
Suffix: | |
Gender: | F |
Credentials: | P T |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4568 S HIGHLAND DR STE 180 |
Mailing Address - Street 2: | |
Mailing Address - City: | SALT LAKE CITY |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84117-4236 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-251-0257 |
Mailing Address - Fax: | 801-251-0259 |
Practice Address - Street 1: | 4568 S HIGHLAND DR STE 180 |
Practice Address - Street 2: | |
Practice Address - City: | SALT LAKE CITY |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84117-4236 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-251-0257 |
Practice Address - Fax: | 801-251-0259 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-04-24 |
Last Update Date: | 2013-04-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 2775252401 | 225100000X, 2251C2600X, 2251G0304X, 2251H1200X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |