Provider Demographics
NPI:1780332999
Name:LEE, AUSTIN (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 SACRAMENTO DR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1338
Mailing Address - Country:US
Mailing Address - Phone:856-628-5059
Mailing Address - Fax:
Practice Address - Street 1:670 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1020
Practice Address - Country:US
Practice Address - Phone:856-423-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002920002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer