MEDICARE: MR. TIMOTHY LIU DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40826	CA

General Provider Information

NPI Number	:	1619398872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY LIU DPT

Provider Business Mailing Address
First Line	:	1040 N RENGSTORFF AVE
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1750
Country	:	US
Telephone Number	:	650-967-5100
Fax Number	:	650-967-5101

Provider Business Practice Location Address
First Line	:	1040 N RENGSTORFF AVE
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1750
Country	:	US
Telephone Number	:	650-967-5100
Fax Number	:	650-967-5101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	09/20/2016

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