Provider Demographics
NPI:1790875235
Name:LEE, CHRISTINA LYNN (MSPT, OCS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:LEE
Suffix:
Gender:F
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 BRIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2247
Mailing Address - Country:US
Mailing Address - Phone:949-857-0759
Mailing Address - Fax:
Practice Address - Street 1:1910 OLD TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7811
Practice Address - Country:US
Practice Address - Phone:714-835-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT18461AMedicare PIN