Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA000157 | DC |
NPI | 1013431832 |
---|---|
Provider Name | Andre E P Lee |
First Address | Washington, DC 20006-3766 |
Second Address | Washington, DC 20006-3766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2017 |
Last Update Date | 02/08/2017 |