MEDICARE: HAO LI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT005796	KY

General Provider Information

NPI Number	:	1013261338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAO LI DPT

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:	800-944-9782
Fax Number	:	610-438-2046

Provider Business Practice Location Address
First Line	:	620 VALLEY COLLEGE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2794
Country	:	US
Telephone Number	:	502-093-3791
Fax Number	:	502-933-7919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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