Provider Demographics
NPI:1659978468
Name:LI, GUOWEI
Entity Type:Individual
Prefix:
First Name:GUOWEI
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 GAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6602
Mailing Address - Country:US
Mailing Address - Phone:617-708-5729
Mailing Address - Fax:
Practice Address - Street 1:11 VANDERBILT AVE STE 210
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5056
Practice Address - Country:US
Practice Address - Phone:781-688-0138
Practice Address - Fax:781-269-5613
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist