Provider Demographics
NPI:1710706080
Name:GU, JIAXUAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JIAXUAN
Middle Name:
Last Name:GU
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 1:203 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1344
Mailing Address - Country:US
Mailing Address - Phone:508-651-0051
Mailing Address - Fax:508-651-0061
Practice Address - Street 1:54 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3208
Practice Address - Country:US
Practice Address - Phone:781-237-0400
Practice Address - Fax:781-237-0400
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL26462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist