Healthcare Provider Details

I. General information

NPI: 1124933064
Provider Name (Legal Business Name): YICHENG LU PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES LU PT, DPT

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BROADWAY # A
SAUGUS MA
01906-1094
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 781-941-5002
  • Fax:
Mailing address:
  • Phone: 630-296-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: