Provider Demographics
NPI:1659049773
Name:LEE, JAYME VICTORIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:VICTORIA
Last Name:LEE
Suffix:
Gender:F
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 1:1804 CAMINO VERDE APT O
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2261
Mailing Address - Country:US
Mailing Address - Phone:916-660-6250
Mailing Address - Fax:
Practice Address - Street 1:1401 CIVIC CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5211
Practice Address - Country:US
Practice Address - Phone:925-301-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist