Provider Demographics
NPI:1285869446
Name:LEE, VALERIE ANNE (PT DPT)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
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 1:540 RALSTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2866
Mailing Address - Country:US
Mailing Address - Phone:650-363-5668
Mailing Address - Fax:650-363-5669
Practice Address - Street 1:540 RALSTON AVE STE B
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2866
Practice Address - Country:US
Practice Address - Phone:650-363-5668
Practice Address - Fax:650-363-5669
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX480ZMedicare PIN
CAZZZ06873ZMedicare PIN