Provider Demographics
NPI:1497897086
Name:LEE, JOO
Entity Type:Individual
Prefix:MS
First Name:JOO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:J
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3701 CONSHOHOCKEN AVE
Mailing Address - Street 2:APT 520
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5539
Mailing Address - Country:US
Mailing Address - Phone:267-902-8225
Mailing Address - Fax:
Practice Address - Street 1:3701 CONSHOHOCKEN AVE
Practice Address - Street 2:APT 520
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5539
Practice Address - Country:US
Practice Address - Phone:267-902-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016033-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist