Healthcare Provider Details

I. General information

NPI: 1548037138
Provider Name (Legal Business Name): RYAN H LEE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16412 LOS GATOS BLVD
LOS GATOS CA
95032-5525
US

IV. Provider business mailing address

17 WINDING WAY
SEA CLIFF NY
11579-1115
US

V. Phone/Fax

Practice location:
  • Phone: 949-878-1859
  • Fax:
Mailing address:
  • Phone: 949-878-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: