Healthcare Provider Details

I. General information

NPI: 1205713880
Provider Name (Legal Business Name): JONATHAN LIANG PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W 44TH ST FL 2
NEW YORK NY
10036-4013
US

IV. Provider business mailing address

1940 W 10TH ST
BROOKLYN NY
11223-2544
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-7427
  • Fax:
Mailing address:
  • Phone: 917-428-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: