Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160033075 | WA |
NPI | 1013313055 |
---|---|
Provider Name | Burton Lee |
First Address | Tacoma, WA 98408-1317 |
Second Address | Tacoma, WA 98408-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2014 |
Last Update Date | 18/11/2014 |