Provider Demographics
NPI:1730738576
Name:LEE, MATTHEW WESLEY (DPT, PT, C-RDN1)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WESLEY
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT, PT, C-RDN1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 COVE VIEW BLVD APT 3218
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554-8185
Mailing Address - Country:US
Mailing Address - Phone:936-522-8251
Mailing Address - Fax:
Practice Address - Street 1:7111 MEDICAL CENTER DR STE 111
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2667
Practice Address - Country:US
Practice Address - Phone:409-935-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1322433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist