Healthcare Provider Details

I. General information

NPI: 1134015340
Provider Name (Legal Business Name): STEPHANIE LUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 BROADWAY
LEMON GROVE CA
91945-1406
US

IV. Provider business mailing address

7050 BROADWAY
LEMON GROVE CA
91945-1406
US

V. Phone/Fax

Practice location:
  • Phone: 619-745-5932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: