Provider Demographics
NPI:1003060120
Name:LI, QING EVELYN (L AC, DPT)
Entity Type:Individual
Prefix:
First Name:QING
Middle Name:EVELYN
Last Name:LI
Suffix:
Gender:F
Credentials:L AC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14809 NORTHERN BLVD
Mailing Address - Street 2:1K
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4346
Mailing Address - Country:US
Mailing Address - Phone:646-409-7137
Mailing Address - Fax:
Practice Address - Street 1:14105 NORTHERN BLVD
Practice Address - Street 2:APT. 6F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4247
Practice Address - Country:US
Practice Address - Phone:646-409-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3017171100000X
NY31375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist