Basic Information
| Provider Information | |||||||||
| NPI: | 1265888192 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LIU | ||||||||
| FirstName: | YI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
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| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 HOLLAND ST | ||||||||
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| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021442705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176296040 | ||||||||
| FaxNumber: | 6176296091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 22268 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.