Provider Demographics
NPI:1578794756
Name:LEE, CHRISTOPHER MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:LEE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEMEL CT
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22642-5621
Mailing Address - Country:US
Mailing Address - Phone:540-635-7522
Mailing Address - Fax:540-635-7522
Practice Address - Street 1:1 PARK WEST CIR
Practice Address - Street 2:SUITE 108
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-5551
Practice Address - Country:US
Practice Address - Phone:800-969-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist