Provider Demographics
NPI:1619776994
Name:LEE, JENNIFER FAITH (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAITH
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 W BROAD ST APT 2206
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-4212
Mailing Address - Country:US
Mailing Address - Phone:401-258-7653
Mailing Address - Fax:
Practice Address - Street 1:5135 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5228
Practice Address - Country:US
Practice Address - Phone:470-589-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist