Healthcare Provider Details

I. General information

NPI: 1629914411
Provider Name (Legal Business Name): PAUL LEE DPT, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 154TH ST
FLUSHING NY
11354-5020
US

IV. Provider business mailing address

3508 154TH ST
FLUSHING NY
11354-5020
US

V. Phone/Fax

Practice location:
  • Phone: 949-537-6067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: