Provider Demographics
NPI:1821340944
Name:YU, JIA
Entity Type:Individual
Prefix:MR
First Name:JIA
Middle Name:
Last Name:YU
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 1:1074 NW 13TH ST APT 171C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2238
Mailing Address - Country:US
Mailing Address - Phone:954-821-0931
Mailing Address - Fax:
Practice Address - Street 1:1074 NW 13TH ST
Practice Address - Street 2:APT 171C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2284
Practice Address - Country:US
Practice Address - Phone:954-821-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14713225XG0600X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist