Provider Demographics
NPI:1619152279
Name:LEE, SUJIN
Entity Type:Individual
Prefix:
First Name:SUJIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1101 S JOYCE ST
Mailing Address - Street 2:APT 5234
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2064
Mailing Address - Country:US
Mailing Address - Phone:425-828-1351
Mailing Address - Fax:
Practice Address - Street 1:1101 S JOYCE ST
Practice Address - Street 2:APT 5234
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2064
Practice Address - Country:US
Practice Address - Phone:425-828-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist