Healthcare Provider Details

I. General information

NPI: 1003774373
Provider Name (Legal Business Name): MAGON LIU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 253
BERKELEY CA
94701-0253
US

IV. Provider business mailing address

PO BOX 253
BERKELEY CA
94701-0253
US

V. Phone/Fax

Practice location:
  • Phone: 510-644-8031
  • Fax: 510-644-8036
Mailing address:
  • Phone: 510-644-8031
  • Fax: 510-644-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: