Provider Demographics
NPI:1649522442
Name:LEE, CHRISTINA (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
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 1:15775 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3189
Mailing Address - Country:US
Mailing Address - Phone:949-333-3833
Mailing Address - Fax:949-390-8770
Practice Address - Street 1:15775 LAGUNA CANYON RD.
Practice Address - Street 2:STE. 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3192
Practice Address - Country:US
Practice Address - Phone:949-333-3833
Practice Address - Fax:949-390-8770
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26615208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation