Provider Demographics
NPI:1700805462
Name:LEE, CAROLYN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:2191 MARKET STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1399
Mailing Address - Country:US
Mailing Address - Phone:415-861-1856
Mailing Address - Fax:415-839-8294
Practice Address - Street 1:2191 MARKET STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1399
Practice Address - Country:US
Practice Address - Phone:415-861-1856
Practice Address - Fax:415-839-8294
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25077225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT25077Medicare UPIN
CA0PT250770Medicare PIN