Provider Demographics
NPI:1720520364
Name:ZHAO, XI (MASSAGE & BODYWORK)
Entity Type:Individual
Prefix:MR
First Name:XI
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:MASSAGE & BODYWORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WAYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4354
Mailing Address - Country:US
Mailing Address - Phone:908-392-2292
Mailing Address - Fax:
Practice Address - Street 1:646 ROUTE 18 STE 102
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3722
Practice Address - Country:US
Practice Address - Phone:908-236-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00001700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist