Provider Demographics
NPI:1053885053
Name:XU, KE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KE
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4430 N HOLLAND SYLVANIA RD APT 4145
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3553
Mailing Address - Country:US
Mailing Address - Phone:614-371-1568
Mailing Address - Fax:
Practice Address - Street 1:2801 W BANCROFT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3390
Practice Address - Country:US
Practice Address - Phone:419-530-2051
Practice Address - Fax:419-530-2570
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0063412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer