Healthcare Provider Details

I. General information

NPI: 1467114769
Provider Name (Legal Business Name): YOUNG LIU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 12/30/2024
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LANCASTER AVE
PHILADELPHIA PA
19104-4964
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-0397
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-025511
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT030965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: