Provider Demographics
NPI:1336976844
Name:LEE, MATTHEW WARREN (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WARREN
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36976 MONTECITO DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-2621
Mailing Address - Country:US
Mailing Address - Phone:510-342-4446
Mailing Address - Fax:
Practice Address - Street 1:36976 MONTECITO DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-2621
Practice Address - Country:US
Practice Address - Phone:510-342-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist