Healthcare Provider Details

I. General information

NPI: 1447478110
Provider Name (Legal Business Name): LI L LIU LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26832 MAPLE VALLEY BLACK DIAMOND RD SE
MAPLE VALLEY WA
98038-8309
US

IV. Provider business mailing address

2256 SHELTON AVE NE
RENTON WA
98056-2477
US

V. Phone/Fax

Practice location:
  • Phone: 425-432-9001
  • Fax: 425-432-0838
Mailing address:
  • Phone: 425-301-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: