Provider Demographics
NPI:1487986311
Name:LEE, BENJAMIN S (LMP, ACR, CCST)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:LMP, ACR, CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 3RD AVE APT 713
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1298
Mailing Address - Country:US
Mailing Address - Phone:206-650-4177
Mailing Address - Fax:
Practice Address - Street 1:2608B 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1214
Practice Address - Country:US
Practice Address - Phone:206-235-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021698173C00000X, 174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist