Provider Demographics
NPI:1033388608
Name:LEE, MIJA (RPT)
Entity Type:Individual
Prefix:
First Name:MIJA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 41ST AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4946
Mailing Address - Country:US
Mailing Address - Phone:718-321-8522
Mailing Address - Fax:718-321-8524
Practice Address - Street 1:15015 41ST AVE FL 3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4946
Practice Address - Country:US
Practice Address - Phone:718-321-8522
Practice Address - Fax:718-321-8524
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist