Provider Demographics
NPI:1043697634
Name:GAO, XIANG (DPT)
Entity Type:Individual
Prefix:
First Name:XIANG
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 PARK TRL NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7041
Mailing Address - Country:US
Mailing Address - Phone:616-635-9762
Mailing Address - Fax:
Practice Address - Street 1:1762 PARK TRL NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7041
Practice Address - Country:US
Practice Address - Phone:616-635-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01556700225100000X
NY037554225100000X
MI5501016943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist