Healthcare Provider Details

I. General information

NPI: 1417892704
Provider Name (Legal Business Name): XI LIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 CROSS ST UNIT 1108
PUNTA GORDA FL
33950-5551
US

IV. Provider business mailing address

17181 FALLKIRK AVE
PORT CHARLOTTE FL
33954-1502
US

V. Phone/Fax

Practice location:
  • Phone: 941-655-8513
  • Fax:
Mailing address:
  • Phone: 352-327-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA77515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: