Healthcare Provider Details

I. General information

NPI: 1255388468
Provider Name (Legal Business Name): EUGENE LEE PHYSICAL THERAPY& WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WILLOW LN
THOUSAND OAKS CA
91361-4945
US

IV. Provider business mailing address

2550 WILLOW LN
THOUSAND OAKS CA
91361-4945
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7829
  • Fax: 805-497-7839
Mailing address:
  • Phone: 805-497-7829
  • Fax: 805-497-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 22125
License Number StateCA

VIII. Authorized Official

Name: MR. EUGENE LEE
Title or Position: PRESIDENT/PHYSICAL THERAPIST
Credential: M.P.T.
Phone: 805-497-7829