Healthcare Provider Details

I. General information

NPI: 1851626642
Provider Name (Legal Business Name): ELIZABETH M LIEBNER DPT,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

338 S DAKOTA AVE
VANDENBERG AFB CA
93437-6307
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8124
  • Fax:
Mailing address:
  • Phone: 805-606-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1191246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: