Healthcare Provider Details

I. General information

NPI: 1194060095
Provider Name (Legal Business Name): ALBERT JONG-SUK LEE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-2198
  • Fax:
Mailing address:
  • Phone: 571-231-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24118
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT31107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: