Healthcare Provider Details

I. General information

NPI: 1376619403
Provider Name (Legal Business Name): GRACEE LEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACEE LEE PA

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 KNOWLES DR STE 219
LOS GATOS CA
95032-1551
US

IV. Provider business mailing address

555 KNOWLES DR STE 219
LOS GATOS CA
95032-1551
US

V. Phone/Fax

Practice location:
  • Phone: 408-866-3874
  • Fax:
Mailing address:
  • Phone: 408-866-3874
  • Fax: 650-447-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22931
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: