Active NPI
Jaewon Lee
- Physical Therapist
- Orange Park, FL
National Provider Identifier
1396625372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 43363
- Practice address
- 151 College Dr
Orange Park, FL 32065-7683 - Phone
- (904) 604-8369
- NPI assigned
- Sep 2, 2025
- Last updated
- Sep 2, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 43363 | FL | Primary |
Addresses
Primary practice location
151 College Dr
Orange Park, FL 32065-7683
Mailing address
4538 Plymouth St
Jacksonville, FL 32205-7116
Phone (904) 460-6523
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43363 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756771200000",
"number": "1396625372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4538 PLYMOUTH ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322057116",
"telephone_number": "904-460-6523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 COLLEGE DR",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320657683",
"telephone_number": "904-604-8369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAEWON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-02",
"last_updated": "2025-09-02",
"certification_date": "2025-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "43363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.