Provider Demographics
NPI:1306215900
Name:LEE, SOOKYUNG (DPT)
Entity Type:Individual
Prefix:
First Name:SOOKYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 24TH ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:716-548-9397
Mailing Address - Fax:
Practice Address - Street 1:16 GARDENIA LN
Practice Address - Street 2:ACE HEALTHCARE RESOURCES, LLC
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2009
Practice Address - Country:US
Practice Address - Phone:716-548-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist