Provider Demographics
NPI:1629085162
Name:LEE, JAMES K (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2755 BRISTOL ST
Mailing Address - Street 2:130
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5985
Mailing Address - Country:US
Mailing Address - Phone:714-966-2950
Mailing Address - Fax:714-557-2487
Practice Address - Street 1:2755 BRISTOL ST
Practice Address - Street 2:130
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5985
Practice Address - Country:US
Practice Address - Phone:714-966-2950
Practice Address - Fax:714-557-2487
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT320670OtherBLUE SHIELD PIN
CAWPT32067AMedicare PIN
CAQ56297Medicare UPIN