Provider Demographics
NPI:1285686782
Name:LE, TIEN JUSTIN (PT)
Entity Type:Individual
Prefix:
First Name:TIEN
Middle Name:JUSTIN
Last Name:LE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:TIEN
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9362 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1507
Mailing Address - Country:US
Mailing Address - Phone:714-489-1922
Mailing Address - Fax:
Practice Address - Street 1:4201 W CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1505
Practice Address - Country:US
Practice Address - Phone:714-748-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist