Healthcare Provider Details

I. General information

NPI: 1275872095
Provider Name (Legal Business Name): JUSTIN WU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 TRAPELO RD UNIT 2
BELMONT MA
02478-1417
US

IV. Provider business mailing address

107 COLLEGE RD
CONCORD MA
01742-1526
US

V. Phone/Fax

Practice location:
  • Phone: 978-500-3003
  • Fax:
Mailing address:
  • Phone: 978-369-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20432
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number20432
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: