Provider Demographics
NPI:1447584412
Name:LEE, JOHN SOO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SOO
Last Name:LEE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2023
Mailing Address - Country:US
Mailing Address - Phone:201-310-0228
Mailing Address - Fax:
Practice Address - Street 1:144 BROADWAY
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2023
Practice Address - Country:US
Practice Address - Phone:201-310-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01332400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist