Healthcare Provider Details

I. General information

NPI: 1164959904
Provider Name (Legal Business Name): ALBERT LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 JORDAN AVE
JUNEAU AK
99801-8050
US

IV. Provider business mailing address

3444 NOWELL AVE # 306C
JUNEAU AK
99801-1980
US

V. Phone/Fax

Practice location:
  • Phone: 907-789-9549
  • Fax: 907-789-3520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101441
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: