Provider Demographics
NPI:1528515111
Name:LEE, DUSTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
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 1:280 INTERSTATE NORTH CIR SE STE 105
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2450
Mailing Address - Country:US
Mailing Address - Phone:678-608-1700
Mailing Address - Fax:678-608-1699
Practice Address - Street 1:280 INTERSTATE NORTH CIR SE STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2450
Practice Address - Country:US
Practice Address - Phone:678-608-1700
Practice Address - Fax:678-608-1699
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0125812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic