Provider Demographics
NPI:1003787391
Name:LI, QINGQING
Entity type:Individual
Prefix:
First Name:QINGQING
Middle Name:
Last Name:LI
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 HONEA EGYPT RD # 512
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2568
Mailing Address - Country:US
Mailing Address - Phone:818-284-2949
Mailing Address - Fax:
Practice Address - Street 1:506 HONEA EGYPT RD # 512
Practice Address - Street 2:512
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2568
Practice Address - Country:US
Practice Address - Phone:818-284-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT141911225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist