Healthcare Provider Details

I. General information

NPI: 1861079949
Provider Name (Legal Business Name): TAO TONY LIU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 DOVER COMMONS DRIVE
ATLANTA GA
30342-3034
US

IV. Provider business mailing address

183 DOVER COMMONS DR
TUCKER GA
30084-8469
US

V. Phone/Fax

Practice location:
  • Phone: 770-381-8240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015158
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: