Healthcare Provider Details

I. General information

NPI: 1811299233
Provider Name (Legal Business Name): PEGGY K WU MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 E LIVE OAK AVE
ARCADIA CA
91006-5752
US

IV. Provider business mailing address

609 E NEWMARK AVE
MONTEREY PARK CA
91755-3105
US

V. Phone/Fax

Practice location:
  • Phone: 626-841-1115
  • Fax:
Mailing address:
  • Phone: 626-429-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number29458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: