Provider Demographics
NPI:1992499461
Name:XU, RUNTAI (DPT, PT)
Entity type:Individual
Prefix:
First Name:RUNTAI
Middle Name:
Last Name:XU
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 1:24619 BARDONA WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5013
Mailing Address - Country:US
Mailing Address - Phone:813-327-3356
Mailing Address - Fax:
Practice Address - Street 1:23780 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1529
Practice Address - Country:US
Practice Address - Phone:281-358-1838
Practice Address - Fax:281-358-1812
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1377615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist