Provider Demographics
NPI:1639606189
Name:PRIEBE, LEE ANTON (PT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANTON
Last Name:PRIEBE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3210
Mailing Address - Country:US
Mailing Address - Phone:805-901-0459
Mailing Address - Fax:
Practice Address - Street 1:117 S EMMA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3210
Practice Address - Country:US
Practice Address - Phone:805-901-0459
Practice Address - Fax:805-901-0459
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist