Healthcare Provider Details

I. General information

NPI: 1801517248
Provider Name (Legal Business Name): JESSICA LEANN LIERMANN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39815 ALTA MURRIETA DR STE C1
MURRIETA CA
92563-5405
US

IV. Provider business mailing address

28520 VIA PRINCESA APT A
MURRIETA CA
92563-7700
US

V. Phone/Fax

Practice location:
  • Phone: 951-304-7673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: