Provider Demographics
NPI:1922045608
Name:LEE, KATHERINE B (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2837
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2837
Mailing Address - Country:US
Mailing Address - Phone:706-868-1707
Mailing Address - Fax:706-868-1351
Practice Address - Street 1:685 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5130
Practice Address - Country:US
Practice Address - Phone:706-868-1707
Practice Address - Fax:706-868-1351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist