Provider Demographics
NPI:1235678343
Name:LEE, ANDREW Y
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 DAVIS LN
Mailing Address - Street 2:APT 2027
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4540
Mailing Address - Country:US
Mailing Address - Phone:505-440-1506
Mailing Address - Fax:
Practice Address - Street 1:5167 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5349
Practice Address - Country:US
Practice Address - Phone:503-967-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist