Healthcare Provider Details

I. General information

NPI: 1548794506
Provider Name (Legal Business Name): EVANGELINE LIU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANGELINE JI LIU DPT

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 INVERNESS DR E STE 120
ENGLEWOOD CO
80112-5172
US

IV. Provider business mailing address

6980 MESA RIDGE PKWY
FOUNTAIN CO
80817-1563
US

V. Phone/Fax

Practice location:
  • Phone: 720-324-9380
  • Fax:
Mailing address:
  • Phone: 719-391-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292942
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0016719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: