MEDICARE: MAINING FU MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	118989	TX

General Provider Information

NPI Number	:	1669109070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAINING FU MS

Provider Business Mailing Address
First Line	:	3125 MCCART AVE APT 311
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3680
Country	:	US
Telephone Number	:	817-524-5314
Fax Number	:

Provider Business Practice Location Address
First Line	:	5917 SHELTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3933
Country	:	US
Telephone Number	:	817-524-5314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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Directions to “ MAINING FU MS” Practice Location

Language	Start Address	Practice Location

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