Healthcare Provider Details

I. General information

NPI: 1710807045
Provider Name (Legal Business Name): STEVEN LEE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106-D GALLOWS RD
VIENNA VA
22182
US

IV. Provider business mailing address

3060 16TH ST NW APT 306
WASHINGTON DC
20009-4238
US

V. Phone/Fax

Practice location:
  • Phone: 626-200-7328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020272
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: