MEDICARE: TAO TONY LIU 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	015158	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861079949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAO TONY LIU DPT

Provider Business Mailing Address
First Line	:	183 DOVER COMMONS DR
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-8469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 DOVER COMMONS DRIVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3034
Country	:	US
Telephone Number	:	770-381-8240
Fax Number	:

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

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	03/25/2021

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Directions to “ TAO TONY LIU DPT” Practice Location

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