Provider Demographics
NPI:1205026838
Name:MCGILL, LIZA TRINIDAD (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:TRINIDAD
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 AMHERST AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0510
Mailing Address - Country:US
Mailing Address - Phone:310-820-8837
Mailing Address - Fax:
Practice Address - Street 1:14650 AVIATION BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6668
Practice Address - Country:US
Practice Address - Phone:310-725-8505
Practice Address - Fax:310-725-8509
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist