Healthcare Provider Details

I. General information

NPI: 1386000537
Provider Name (Legal Business Name): HONG LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 TYVOLA RD
CHARLOTTE NC
28217-3508
US

IV. Provider business mailing address

100 MANNING DR
CHARLOTTE NC
28209-3432
US

V. Phone/Fax

Practice location:
  • Phone: 704-525-9909
  • Fax:
Mailing address:
  • Phone: 704-877-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1734
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: