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General NPI Number Information
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NPI Number | 1255388468
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Entity Type | Organization
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Legal Business Name | EUGENE LEE PHYSICAL THERAPY& WELLNESS CENTER
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2550 WILLOW LN
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-4945
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Country | US
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Telephone | 805-497-7829
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Fax | 805-497-7839
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Provider Business Mailing Address
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Address Line | 2550 WILLOW LN
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-4945
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Country | US
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Telephone | 805-497-7829
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Fax | 805-497-7839
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | MR. EUGENE LEE
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Credential | M.P.T.
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Telephone | 805-497-7829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 22125
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License Number State | CA
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