Provider Demographics
NPI:1033124466
Name:XU, ANDY XIN (RPT)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:XIN
Last Name:XU
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 MADELINE COVE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4605
Mailing Address - Country:US
Mailing Address - Phone:310-531-3755
Mailing Address - Fax:
Practice Address - Street 1:23832 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5209
Practice Address - Country:US
Practice Address - Phone:310-326-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT17897Medicare ID - Type UnspecifiedPROVIDER NUMBER