Provider Demographics
NPI:1659310233
Name:LEE, CHRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:5029 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2826
Practice Address - Country:US
Practice Address - Phone:425-252-1642
Practice Address - Fax:425-258-1824
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911745305-98203-C005OtherTRICARE
WAP00020869OtherRAILROAD MEDICARE
WA8337636Medicaid
WA911745305-98223-A015OtherTRICARE
WA9687LEOtherREGENCE BLUE SHIELD
WA6587LEOtherREGENCE BLUE SHIELD
WA7063410OtherAETNA
WA3752LEOtherREGENCE BLUE SHIELD
WA8930487OtherL&I CRIME VICTIMS
WA911745305-98208-B023OtherTRICARE
WA0201976OtherDEPT. OF LABOR & INDUSTRY
WA911745305-98275-A006OtherTRICARE
WA5029LEOtherREGENCE BLUE SHIELD
WA7063410OtherAETNA