Healthcare Provider Details

I. General information

NPI: 1952812661
Provider Name (Legal Business Name): JIA LIANG LI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST STE 4
NEEDHAM HEIGHTS MA
02494-3133
US

IV. Provider business mailing address

220 RESERVOIR ST STE 4
NEEDHAM HEIGHTS MA
02494-3133
US

V. Phone/Fax

Practice location:
  • Phone: 617-294-5888
  • Fax:
Mailing address:
  • Phone: 617-294-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23024
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: