Provider Demographics
NPI:1881228369
Name:LEE, JOSHUA JIMMY (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JIMMY
Last Name:LEE
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30687 RATEKIN DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1662
Mailing Address - Country:US
Mailing Address - Phone:650-863-4898
Mailing Address - Fax:
Practice Address - Street 1:1100 INDUSTRIAL RD STE 11A
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4167
Practice Address - Country:US
Practice Address - Phone:650-593-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2981802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic