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General NPI Number Information
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NPI Number | 1043506330
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Entity Type | Individual
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Provider Name | JASON MICHAEL LEE
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Gender | Male
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 8142 S STATE ST ATE 103
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City | MIDVALE
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State | UT
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Zip | 84047-3210
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Country | US
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Telephone | 801-708-9226
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Fax | 877-822-8366
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Provider Business Mailing Address
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Address Line | 7529 STONE RD
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-5237
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Country | US
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Telephone | 801-943-8513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 341753-2401
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License Number State | UT
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