Provider Demographics
NPI:1306528476
Name:WU, JONATHAN WILLIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WILLIS
Last Name:WU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 EL DORADO CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3626
Mailing Address - Country:US
Mailing Address - Phone:510-364-5553
Mailing Address - Fax:
Practice Address - Street 1:20823 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2108
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3045472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty