Provider Demographics
NPI:1295027456
Name:LEE, SEUNG WOON (DPT)
Entity Type:Individual
Prefix:
First Name:SEUNG WOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 MURRAY ST
Mailing Address - Street 2:# 2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3948
Mailing Address - Country:US
Mailing Address - Phone:718-888-1704
Mailing Address - Fax:718-961-2459
Practice Address - Street 1:3409 MURRAY STREET 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5942
Practice Address - Country:US
Practice Address - Phone:718-888-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030089OtherLICENSE