Provider Demographics
NPI:1104369883
Name:JIA, ZHAOYU
Entity Type:Individual
Prefix:MS
First Name:ZHAOYU
Middle Name:
Last Name:JIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 KISSENA BLVD APT 517
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3201
Mailing Address - Country:US
Mailing Address - Phone:917-858-8570
Mailing Address - Fax:
Practice Address - Street 1:86-09 51ST AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:917-858-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040940225100000X
NC006285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist