Provider Demographics
NPI:1720556558
Name:LEE, VINCENT YANG (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:YANG
Last Name:LEE
Suffix:
Gender:M
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 1:1835 EASTWEST PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-5310
Mailing Address - Country:US
Mailing Address - Phone:904-215-6111
Mailing Address - Fax:
Practice Address - Street 1:1835 EASTWEST PKWY STE 5
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-5310
Practice Address - Country:US
Practice Address - Phone:904-215-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013030493OtherACUPUNCTURE