Healthcare Provider Details

I. General information

NPI: 1093620957
Provider Name (Legal Business Name): BENJAMIN LIU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5827 HIGHWAY 90
MILTON FL
32583-1763
US

IV. Provider business mailing address

4520 N LANDMARK DR
ORLANDO FL
32817-1233
US

V. Phone/Fax

Practice location:
  • Phone: 850-983-8583
  • Fax:
Mailing address:
  • Phone: 407-733-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: