Provider Demographics
NPI:1649976671
Name:LEE, SARAH IRENE (CMT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:IRENE
Last Name:LEE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3114
Mailing Address - Country:US
Mailing Address - Phone:310-372-2063
Mailing Address - Fax:
Practice Address - Street 1:2310 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3114
Practice Address - Country:US
Practice Address - Phone:310-372-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314652225700000X
225700000X
CA30074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist