Provider Demographics
NPI:1366702623
Name:LEE, DANIEL FREDERICK (LMT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FREDERICK
Last Name:LEE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:9 MONROE STREET
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0168
Mailing Address - Country:US
Mailing Address - Phone:716-699-2508
Mailing Address - Fax:
Practice Address - Street 1:9 MONROE ST
Practice Address - Street 2:
Practice Address - City:ELLICOTTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14731-9607
Practice Address - Country:US
Practice Address - Phone:716-699-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist