Provider Demographics
NPI:1811672801
Name:LU, JUN TAO (PTA/MT)
Entity type:Individual
Prefix:MR
First Name:JUN TAO
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:PTA/MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 N GARFIELD AVE, SUITE A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-280-2818
Mailing Address - Fax:626-280-2848
Practice Address - Street 1:318 N GARFIELD AVE, SUITE A
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-280-2818
Practice Address - Fax:626-280-2848
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist