Individual provider Active NPI

Katherine Lee

  • Physical Therapist
  • Fairfax, VA
National Provider Identifier
1568647097
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305205110 Issued in VA
Practice address
4485B Beacon Grove Cir
Fairfax, VA 22033-6039
Phone
(703) 864-5323
NPI assigned
Jan 3, 2008
Last updated
Jun 29, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305205110 VA Primary

Addresses

Primary practice location

4485B Beacon Grove Cir
Fairfax, VA 22033-6039

Mailing address

4485B Beacon Grove Cir
Fairfax, VA 22033-6039
Phone (703) 864-5323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220329002866 VA Practitioner - Physical Therapist in Private Practice 5496893059 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305205110VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Nov 19, 2021 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Nov 19, 2021 Accepting new patients
In-Home Physical Therapy PC PastSince Nov 1, 2019 Accepting new patients

Locations

110 Horizon Dr
#310
Raleigh, NC 27615

3365 Ogden Rd
Roanoke, VA 24018
Phone (540) 682-7500

1853 Old Donation Pkwy
Virginia Beach, VA 23454
Phone (757) 412-1180

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1568647097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4485B BEACON GROVE CIR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220336039",
            "telephone_number": "703-864-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4485B BEACON GROVE CIR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220336039",
            "telephone_number": "703-864-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-03",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305205110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.