Provider Demographics
NPI:1861296543
Name:LEE, JEY D (PTA)
Entity type:Individual
Prefix:
First Name:JEY
Middle Name:D
Last Name:LEE
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25129 THE OLD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-2281
Mailing Address - Country:US
Mailing Address - Phone:661-284-1984
Mailing Address - Fax:
Practice Address - Street 1:25129 THE OLD RD STE 100
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-2281
Practice Address - Country:US
Practice Address - Phone:661-284-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49928225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant