Provider Demographics
NPI:1205230125
Name:LIZARDO, ALICE THUY-TIEN NGOC (DPT)
Entity Type:Individual
Prefix:
First Name:ALICE THUY-TIEN
Middle Name:NGOC
Last Name:LIZARDO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICE THUY-TIEN
Other - Middle Name:NGOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:291 E MAIN ST
Mailing Address - Street 2:STE E
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6137
Mailing Address - Country:US
Mailing Address - Phone:310-273-0877
Mailing Address - Fax:
Practice Address - Street 1:415 N CRESCENT DR
Practice Address - Street 2:130
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4860
Practice Address - Country:US
Practice Address - Phone:310-273-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist