Provider Demographics
NPI:1760467617
Name:LEE, JANET WAH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:WAH
Last Name:LEE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3653
Mailing Address - Country:US
Mailing Address - Phone:877-390-6659
Mailing Address - Fax:916-913-5646
Practice Address - Street 1:68 WILLOW RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3653
Practice Address - Country:US
Practice Address - Phone:877-390-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT116590Medicare PIN