Provider Demographics
NPI:1942776083
Name:LEE, YOUNJAE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:YOUNJAE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 OLD FRANCONIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3408
Mailing Address - Country:US
Mailing Address - Phone:813-486-6131
Mailing Address - Fax:
Practice Address - Street 1:6200 OLD FRANCONIA RD STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3408
Practice Address - Country:US
Practice Address - Phone:813-486-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist