Healthcare Provider Details

I. General information

NPI: 1699508861
Provider Name (Legal Business Name): BERNARD XU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD STE U15-16
BERWYN HEIGHTS MD
20740-2354
US

IV. Provider business mailing address

7813 MORNINGDEW DR
PLANO TX
75025-3748
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-0571
  • Fax:
Mailing address:
  • Phone: 214-718-9713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP033565T
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1399387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: