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General NPI Number Information
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NPI Number | 1477035129
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Entity Type | Individual
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Provider Name | JUAN WU
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Gender | Female
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 2112 FORUM PKWY
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City | BEDFORD
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State | TX
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Zip | 76021-6028
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Country | US
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Telephone | 817-799-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 8732 BRUSHY CREEK TRL
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City | FORT WORTH
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State | TX
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Zip | 76118-7420
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Country | US
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Telephone | 214-983-0637
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 119197
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License Number State | TX
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