Provider Demographics
NPI:1033425558
Name:LIETZAN, MARJA LIISA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MARJA
Middle Name:LIISA
Last Name:LIETZAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-065 KONOHIKI ST APT 3666
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-6136
Mailing Address - Country:US
Mailing Address - Phone:808-489-5620
Mailing Address - Fax:
Practice Address - Street 1:94-801 FARRINGTON HWY
Practice Address - Street 2:WAIPAHU PROFESSIONAL CENTER
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3164
Practice Address - Country:US
Practice Address - Phone:808-680-9123
Practice Address - Fax:808-680-9889
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist