Provider Demographics
NPI:1386538726
Name:XIE, WILSON (DPT, PT)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:XIE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17438 VIA FRANCES
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2628
Mailing Address - Country:US
Mailing Address - Phone:510-331-1278
Mailing Address - Fax:
Practice Address - Street 1:5976 W LAS POSITAS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8506
Practice Address - Country:US
Practice Address - Phone:925-426-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist