Provider Demographics
NPI:1295947125
Name:WEN-LI LU,LLC
Entity type:Organization
Organization Name:WEN-LI LU,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WEN-LI
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:301-977-7782
Mailing Address - Street 1:4 HENLEY COURT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-977-7782
Mailing Address - Fax:
Practice Address - Street 1:16220 S FREDERICK AVENUE
Practice Address - Street 2:SUITE 512
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4022
Practice Address - Country:US
Practice Address - Phone:301-977-7782
Practice Address - Fax:301-977-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N025OtherCAREFIRST BL CR BL SH
N025OtherCAREFIRST BL CR BL SH
G02129Medicare ID - Type Unspecified