Provider Demographics
NPI:1023733763
Name:LEE, CHRISTINA ELLEN (PT, MPH, PHD, MS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELLEN
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, MPH, PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CROWN FARM DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4503
Mailing Address - Country:US
Mailing Address - Phone:317-600-5148
Mailing Address - Fax:
Practice Address - Street 1:132 CROWN FARM DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4503
Practice Address - Country:US
Practice Address - Phone:317-732-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist