Healthcare Provider Details

I. General information

NPI: 1407974728
Provider Name (Legal Business Name): VICTORIA LIU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 OLIVER PL
DUBLIN CA
94568-1380
US

IV. Provider business mailing address

8806 OLIVER PL
DUBLIN CA
94568-1380
US

V. Phone/Fax

Practice location:
  • Phone: 917-776-5378
  • Fax:
Mailing address:
  • Phone: 917-776-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT27483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: