Healthcare Provider Details

I. General information

NPI: 1235678343
Provider Name (Legal Business Name): ANDREW Y LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5167 RIVER RD N
KEIZER OR
97303-5349
US

IV. Provider business mailing address

4825 DAVIS LN APT 2027
AUSTIN TX
78749-4540
US

V. Phone/Fax

Practice location:
  • Phone: 503-967-7874
  • Fax:
Mailing address:
  • Phone: 505-440-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1286975
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: