MEDICARE: DAVID LIAO JR.

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	208100000X	Physical Medicine & Rehabilitation Physician	5502005126	MI
2	225200000X	Physical Therapy Assistant	4802953	MI

General Provider Information

NPI Number	:	1700402559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LIAO JR.

Provider Business Mailing Address
First Line	:	27116 TOWNLEY ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3379
Country	:	US
Telephone Number	:	734-679-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 ORLEANS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2769
Country	:	US
Telephone Number	:	248-577-2632
Fax Number	:

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/28/2020

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Directions to “ DAVID LIAO JR. ” Practice Location

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