Provider Demographics
NPI:1679695787
Name:LEE, ALLEN LANCEFORD (PT, MPH)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:LANCEFORD
Last Name:LEE
Suffix:
Gender:M
Credentials:PT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 LE CLAIRE PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6810
Mailing Address - Country:US
Mailing Address - Phone:323-935-2187
Mailing Address - Fax:323-783-7409
Practice Address - Street 1:3699 WILSHIRE BL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:323-783-1902
Practice Address - Fax:323-783-7409
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist