Individual
BRUCE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1920 MAPLE AVE, LISLE, IL 60532-2179
(800) 974-4378
(262) 697-6278
Mailing address
2547 PLAINFIELD NAPERVILLE RD, STE 152, NAPERVILLE, IL 60564-8909
(800) 974-4378
(262) 697-6278
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070015687
IL
Other
Enumeration date
02/28/2013
Last updated
02/28/2013
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