1730738576 NPI number — MATTHEW WESLEY LEE DPT, PT, C-RDN1

Table of content: MATTHEW WESLEY LEE DPT, PT, C-RDN1 (NPI 1730738576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730738576 NPI number — MATTHEW WESLEY LEE DPT, PT, C-RDN1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
MATTHEW
Provider Middle Name:
WESLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, PT, C-RDN1
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730738576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3433 COVE VIEW BLVD APT 3218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77554-8185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-522-8251
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7111 MEDICAL CENTER DR STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXAS CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77591-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-935-2840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1322433 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com