Healthcare Provider Details

I. General information

NPI: 1477211308
Provider Name (Legal Business Name): ERIC LEE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 1ST ST STE 194
LIVERMORE CA
94551-4915
US

IV. Provider business mailing address

3949 PORTOLA CMN UNIT 3
LIVERMORE CA
94551-4848
US

V. Phone/Fax

Practice location:
  • Phone: 925-344-3104
  • Fax:
Mailing address:
  • Phone: 925-344-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: