Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1619642162 |
---|---|
Provider Name | Matthew Lee |
First Address | Pinole, CA 94564-1813 |
Second Address | Redwood City, CA 94063-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 16/08/2021 |