Provider Demographics
NPI:1134629157
Name:TEE, STANLEY BRIAN (PT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:BRIAN
Last Name:TEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:S
Other - Middle Name:BRIAN
Other - Last Name:TEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:106 N DENTON TAP RD STE 220
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2139
Practice Address - Country:US
Practice Address - Phone:630-296-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1301502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist