Provider Demographics
NPI:1770384554
Name:LEE, ROBERT EARL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:LEE
Suffix:
Gender:M
Credentials:PT, DPT
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 204
Mailing Address - Street 2:
Mailing Address - City:NEWHEBRON
Mailing Address - State:MS
Mailing Address - Zip Code:39140-0204
Mailing Address - Country:US
Mailing Address - Phone:601-320-8650
Mailing Address - Fax:
Practice Address - Street 1:235 SINGLETON RIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9136
Practice Address - Country:US
Practice Address - Phone:843-353-3460
Practice Address - Fax:843-353-3461
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7774225100000X
SCCP043017T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist