Provider Demographics
NPI:1265064950
Name:LEE, ELIOT JUSTIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:JUSTIN
Last Name:LEE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3388 CAMINITO VASTO
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2919
Mailing Address - Country:US
Mailing Address - Phone:858-229-6873
Mailing Address - Fax:
Practice Address - Street 1:3737 MORAGA AVE STE B117
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5358
Practice Address - Country:US
Practice Address - Phone:858-270-0981
Practice Address - Fax:858-270-2901
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist