=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386538726
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILSON XIE DPT, PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5976 W LAS POSITAS BLVD STE 110
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-8506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-426-6986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17438 VIA FRANCES
-----------------------------------------------------
City | SAN LORENZO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94580-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-331-1278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 308174
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------