Provider Demographics
NPI:1730888793
Name:WANG, QI (MT)
Entity type:Individual
Prefix:
First Name:QI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 CYPRESS CREEK PKWY STE A6
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4520
Mailing Address - Country:US
Mailing Address - Phone:346-276-0762
Mailing Address - Fax:
Practice Address - Street 1:5020 CYPRESS CREEK PKWY STE A6
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4520
Practice Address - Country:US
Practice Address - Phone:346-276-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT123472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist