Healthcare Provider Details

I. General information

NPI: 1447647912
Provider Name (Legal Business Name): SCOTT KEN LEE PT, DPT, OCS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 130
BEVERLY HILLS CA
90210-6816
US

IV. Provider business mailing address

215 LA PALOMA AVE
ALHAMBRA CA
91801-3033
US

V. Phone/Fax

Practice location:
  • Phone: 626-710-0660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT297161
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: