Healthcare Provider Details

I. General information

NPI: 1568343242
Provider Name (Legal Business Name): TONY OLIVER LIOU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5019
US

IV. Provider business mailing address

9701 KARAK RD NE
ALBUQUERQUE NM
87122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2025-0234
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: