Provider Demographics
NPI:1215267414
Name:WU, RICHARD GEE-FANG (PTA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GEE-FANG
Last Name:WU
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 N CENTRAL AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2901
Mailing Address - Country:US
Mailing Address - Phone:773-594-0225
Mailing Address - Fax:773-763-5398
Practice Address - Street 1:6445 N CENTRAL AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2901
Practice Address - Country:US
Practice Address - Phone:773-594-0225
Practice Address - Fax:773-763-5398
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005324261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy