Provider Demographics
NPI:1073548103
Name:LUO, QIAN MEI (PT)
Entity Type:Individual
Prefix:MRS
First Name:QIAN
Middle Name:MEI
Last Name:LUO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 CENTRAL AVENUE
Mailing Address - Street 2:# A & # B
Mailing Address - City:CHINA
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-628-9612
Mailing Address - Fax:909-591-9942
Practice Address - Street 1:12421 CENTRAL AVENUE
Practice Address - Street 2:# A & # B
Practice Address - City:CHINA
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-628-9612
Practice Address - Fax:909-591-9942
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT280850Medicare ID - Type Unspecified