Healthcare Provider Details

I. General information

NPI: 1811476807
Provider Name (Legal Business Name): CONNIE LIU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY FL 3
SAN JOSE CA
95119-1106
US

IV. Provider business mailing address

1535 COLT WAY
SAN JOSE CA
95121-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-7160
  • Fax:
Mailing address:
  • Phone: 323-695-8711
  • 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: