Basic Information
| Provider Information | |||||||||
| NPI: | 1659310233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 5029 EVERGREEN WAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982032826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252521642 | ||||||||
| FaxNumber: | 4252581824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 911745305-98203-C005 | 01 | WA | TRICARE | OTHER | P00020869 | 01 | WA | RAILROAD MEDICARE | OTHER | 8337636 | 05 | WA | MEDICAID | 911745305-98223-A015 | 01 | WA | TRICARE | OTHER | 9687LE | 01 | WA | REGENCE BLUE SHIELD | OTHER | 6587LE | 01 | WA | REGENCE BLUE SHIELD | OTHER | 7063410 | 01 | WA | AETNA | OTHER | 3752LE | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8930487 | 01 | WA | L&I CRIME VICTIMS | OTHER | 911745305-98208-B023 | 01 | WA | TRICARE | OTHER | 0201976 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 911745305-98275-A006 | 01 | WA | TRICARE | OTHER | 5029LE | 01 | WA | REGENCE BLUE SHIELD | OTHER |