Healthcare Provider Details

I. General information

NPI: 1174432538
Provider Name (Legal Business Name): WU REN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 S STATE 7
DAVIE FL
33314-6402
US

IV. Provider business mailing address

4920 SW 101ST AVE
COOPER CITY FL
33328-3307
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-3699
  • Fax:
Mailing address:
  • Phone: 954-812-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA91391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: