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General NPI Number Information
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NPI Number | 1639657000
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Entity Type | Organization
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Legal Business Name | LIAGA PHYSICAL THERAPY AND WELLNESS INC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 1672 LILAC ST
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City | CORONA
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State | CA
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Zip | 92882-3936
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Country | US
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Telephone | 951-733-6637
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Fax | 855-249-5318
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Provider Business Mailing Address
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Address Line | 1672 LILAC ST
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City | CORONA
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State | CA
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Zip | 92882-3936
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Country | US
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Telephone | 951-733-6637
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Fax | 855-249-5318
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | COLLEEN MARIE LIAGA
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Credential | PT, DPT, OCS
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Telephone | 951-733-6637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT25203
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License Number State | CA
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