Provider Demographics
NPI:1417619636
Name:WANG, QIUJU (LMT)
Entity Type:Individual
Prefix:MRS
First Name:QIUJU
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:QIUJU
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:14535 JOHN MARSHALL HWY STE 20814535
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4023
Mailing Address - Country:US
Mailing Address - Phone:703-753-1719
Mailing Address - Fax:540-937-7680
Practice Address - Street 1:14535 JOHN MARSHALL HWY STE 208
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4025
Practice Address - Country:US
Practice Address - Phone:703-753-1719
Practice Address - Fax:540-937-7680
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017834225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist