Healthcare Provider Details

I. General information

NPI: 1487986311
Provider Name (Legal Business Name): BENJAMIN S LEE LMP, ACR, CCST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608B 3RD AVE
SEATTLE WA
98121-1214
US

IV. Provider business mailing address

2720 3RD AVE APT 713
SEATTLE WA
98121-1298
US

V. Phone/Fax

Practice location:
  • Phone: 206-235-8062
  • Fax:
Mailing address:
  • Phone: 206-650-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00021698
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021698
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA00021698
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: