Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT27483 | CA |
NPI | 1407974728 |
---|---|
Provider Name | Victoria Liu |
First Address | Dublin, CA 94568-1380 |
Second Address | Dublin, CA 94568-1380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 19/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT 27489 | PT LICENSE (01) | CA |