Healthcare Provider Details

I. General information

NPI: 1518497916
Provider Name (Legal Business Name): LIDA PHYSICAL THERAPY & ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 KISSENA BLVD STE 35
FLUSHING NY
11355-3105
US

IV. Provider business mailing address

4161 KISSENA BLVD STE 35
FLUSHING NY
11355-3105
US

V. Phone/Fax

Practice location:
  • Phone: 718-888-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: GUOXI LIU
Title or Position: LAC
Credential:
Phone: 718-888-0300