Healthcare Provider Details

I. General information

NPI: 1326793506
Provider Name (Legal Business Name): ELISE YING LIU PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 08/06/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 BUSHARD ST
FOUNTAIN VALLEY CA
92708-2836
US

IV. Provider business mailing address

17075 BUSHARD ST
FOUNTAIN VALLEY CA
92708-2836
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4990
  • Fax:
Mailing address:
  • Phone: 714-964-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: