MEDICARE: SEWON LEE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070-025543	IL
2	225100000X	Physical Therapist	30487	MD

General Provider Information

NPI Number	:	1104412139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEWON LEE DPT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	15630 OLD COLUMBIA PIKE STE F
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1617
Country	:	US
Telephone Number	:	240-559-5270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	08/04/2025

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