Provider Demographics
NPI:1013431832
Name:LEE, ANDRE E P (PTA)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:E P
Last Name:LEE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 I ST NW STE 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3766
Mailing Address - Country:US
Mailing Address - Phone:202-669-8098
Mailing Address - Fax:202-525-1249
Practice Address - Street 1:1712 I ST NW STE 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3766
Practice Address - Country:US
Practice Address - Phone:202-669-8098
Practice Address - Fax:202-525-1249
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPTA000157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant