Provider Demographics
NPI:1427778216
Name:MAGDAMO, LEE ANDRIE FERNANDEZ (DPT)
Entity type:Individual
Prefix:DR
First Name:LEE ANDRIE
Middle Name:FERNANDEZ
Last Name:MAGDAMO
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 1:21081 S WESTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1707
Mailing Address - Country:US
Mailing Address - Phone:310-782-3333
Mailing Address - Fax:
Practice Address - Street 1:21081 S WESTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1707
Practice Address - Country:US
Practice Address - Phone:310-782-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302488261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy