Provider Demographics
NPI:1043594336
Name:REN, LIJIA (DPT, ACUPUNTURIST)
Entity Type:Individual
Prefix:
First Name:LIJIA
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:DPT, ACUPUNTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 17TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3927
Mailing Address - Country:US
Mailing Address - Phone:484-591-8637
Mailing Address - Fax:
Practice Address - Street 1:150 S 17TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3927
Practice Address - Country:US
Practice Address - Phone:484-591-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001100171100000X
PAPT020369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist