MEDICARE: MISS PING WU P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070011299	IL
2	225100000X	Physical Therapist	62021171	NY
3	225100000X	Physical Therapist	25239	CA

General Provider Information

NPI Number	:	1053584565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PING WU P.T.

Provider Business Mailing Address
First Line	:	7200 REDWOOD BLVD STE 200
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94945-3247
Country	:	US
Telephone Number	:	415-893-4132
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 REDWOOD BLVD
Second Line	:	SUITE 200
City	:	NOVATO
State	:	CA
Zip	:	94945-3250
Country	:	US
Telephone Number	:	415-847-2333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2022

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Directions to “ MISS PING WU P.T.” Practice Location

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