Provider Demographics
NPI:1639290489
Name:LU, WEN-LI (PT, MS, GCFP)
Entity type:Individual
Prefix:
First Name:WEN-LI
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:PT, MS, GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HENLEY CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16220 FREDERICK AVE
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
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N025OtherCAREFIRST BL CR BL SH
700812OtherACN GROUP
MDQ53397Medicare UPIN
MDG02129Medicare ID - Type Unspecified