Healthcare Provider Details

I. General information

NPI: 1437740206
Provider Name (Legal Business Name): LYDA KALEI LIU MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-957 MAMALAHOA HWY
KAMUELA HI
96743-8415
US

IV. Provider business mailing address

PO BOX 1491
KAMUELA HI
96743-1491
US

V. Phone/Fax

Practice location:
  • Phone: 808-209-7934
  • Fax: 808-883-6262
Mailing address:
  • Phone: 808-987-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1383
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: