Provider Demographics
NPI:1972654440
Name:LEE, JEANNIE S (MPT)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 CHALCEDONY ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2113
Mailing Address - Country:US
Mailing Address - Phone:562-682-5241
Mailing Address - Fax:
Practice Address - Street 1:1569 CHALCEDONY ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2113
Practice Address - Country:US
Practice Address - Phone:562-682-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist