MEDICARE: MR. TIAN LIU MASSAGE THERAPIST

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	225700000X	Massage Therapist	10975	CA

General Provider Information

NPI Number	:	1649528894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIAN LIU MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	10527 SAN PABLO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2820
Country	:	US
Telephone Number	:	510-375-0742
Fax Number	:	510-525-3109

Provider Business Practice Location Address
First Line	:	10527 SAN PABLO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2820
Country	:	US
Telephone Number	:	510-375-0742
Fax Number	:	510-525-3109

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

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	08/20/2012

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