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General NPI Number Information
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NPI Number | 1306528476
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Entity Type | Individual
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Provider Name | JONATHAN WILLIS WU PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 20823 STEVENS CREEK BLVD
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City | CUPERTINO
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State | CA
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Zip | 95014-2108
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Country | US
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Telephone | 408-252-6076
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Fax |
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Provider Business Mailing Address
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Address Line | 161 EL DORADO CMN
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City | FREMONT
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State | CA
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Zip | 94539-3626
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Country | US
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Telephone | 510-364-5553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 304547
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License Number State | CA
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