Healthcare Provider Details

I. General information

NPI: 1376253237
Provider Name (Legal Business Name): JANELLE LIU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 DONLON ST STE 201
VENTURA CA
93003-5668
US

IV. Provider business mailing address

1673 DONLON ST STE 201
VENTURA CA
93003-5668
US

V. Phone/Fax

Practice location:
  • Phone: 805-339-9718
  • Fax: 805-339-9728
Mailing address:
  • Phone: 805-339-9718
  • Fax: 805-339-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: