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General NPI Number Information
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NPI Number | 1922253004
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Entity Type | Individual
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Provider Name | PROSPERA WU DPT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 20001 42ND AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-1872
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Country | US
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Telephone | 718-224-0490
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Fax |
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Provider Business Mailing Address
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Address Line | 22120 64TH AVE
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2325
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Country | US
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Telephone | 718-819-0802
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Fax | 718-819-0802
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 019952
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License Number State | NY
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