Jonathan Lee

NPI #1174057657 in Moscow, Idaho

Provider Information

NPI Number: 1174057657
Entity Type: Individual
Name: Jonathan Lee
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Apr 12, 2017
Last Updated: Apr 12, 2017

Practice Location

Address: 1310 W A ST
Address 2: 102
City: Moscow
State: Idaho
ZIP Code: 83843-4035
Phone: (818) 331-5990

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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