Provider Demographics
NPI:1982011128
Name:LEE, JAMES M (DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2045
Mailing Address - Country:US
Mailing Address - Phone:425-225-5865
Mailing Address - Fax:425-948-6643
Practice Address - Street 1:10821 19TH AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-225-5865
Practice Address - Fax:425-948-6643
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 42590225100000X
WAPT60462380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60462380OtherPHYSICAL THERAPIST LICENSE
WAPT60462380OtherWASHINGTON STATE DEPARTMENT OF LICENSING
CAPT42590OtherSTATE OF CALIFORNIA