Provider Demographics
NPI:1346584323
Name:LEE, COURTNEY TETSUKO (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TETSUKO
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 1:4 SAINT REMY CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1626
Mailing Address - Country:US
Mailing Address - Phone:949-246-0667
Mailing Address - Fax:
Practice Address - Street 1:10162 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4907
Practice Address - Country:US
Practice Address - Phone:714-861-4440
Practice Address - Fax:714-861-4450
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist