Provider Demographics
NPI:1023905569
Name:LEE, DEREK JAMES (DPT, PT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JAMES
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SW INDUSTRIAL WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-323-5864
Mailing Address - Fax:541-323-5865
Practice Address - Street 1:2700 NE 4TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3628
Practice Address - Country:US
Practice Address - Phone:541-323-5864
Practice Address - Fax:541-323-5865
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPENDING225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist