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NPI Code Detail

MEDICARE: MR. LARRY WLLIAM LEE PTA

MEDICARE: MR. LARRY WLLIAM LEE PTA
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
1225200000XPhysical Therapy AssistantAT2608CA

General Provider Information

NPI Number : 1396753653
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY WLLIAM LEE PTA
Provider Business Mailing Address
First Line : 6194 CHADWICK AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92139-3610
Country : US
Telephone Number : 619-475-7565
Fax Number :
Provider Business Practice Location Address
First Line : 102 MILE OF CARS WAY
Second Line :
City : NATIONAL CITY
State : CA
Zip : 91950-6603
Country : US
Telephone Number : 619-474-9211
Fax Number : 619-474-0718
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/08/2007

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