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General NPI Number Information
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NPI Number | 1740655919
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Entity Type | Individual
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Provider Name | MRS. LYDIA GRACE LI
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Gender | Female
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 7811 MONTROSE RD STE 350
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City | POTOMAC
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State | MD
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Zip | 20854-3359
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Country | US
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Telephone | 301-417-8283
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Fax | 301-417-8306
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Provider Business Mailing Address
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Address Line | 13006 FREELAND RD
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City | ROCKVILLE
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State | MD
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Zip | 20853-3031
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Country | US
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Telephone | 347-622-1451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 039664
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28386
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 28386
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 28386
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License Number State | MD
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