MEDICARE: MRS. BRENDA CRISTINE LEE MPT

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	2251P0200X	Pediatric Physical Therapist	23821	CA

General Provider Information

NPI Number	:	1346314085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA CRISTINE LEE MPT

Provider Business Mailing Address
First Line	:	1800 HARRISON ST FL 7
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-3466
Country	:	US
Telephone Number	:	510-625-2856
Fax Number	:	877-738-4262

Provider Business Practice Location Address
First Line	:	285 W BEAMER ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-2510
Country	:	US
Telephone Number	:	530-666-6184
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	12/28/2021

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