Basic Information
| Provider Information | |||||||||
| NPI: | 1992922421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JANELLE | ||||||||
| MiddleName: | JACQUES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4415 SW HUDSON ST | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069380800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19401 40TH AVE W | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256709987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | PT00003660 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.