Healthcare Provider Details

I. General information

NPI: 1407574742
Provider Name (Legal Business Name): GI YU LIU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S WAHANNA RD
SEASIDE OR
97138-7735
US

IV. Provider business mailing address

118 LEWIS AVE
MILLBRAE CA
94030-2522
US

V. Phone/Fax

Practice location:
  • Phone: 503-717-7789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number64208
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: