Provider Demographics
NPI:1235512336
Name:LIAO, JON JAMES (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:JAMES
Last Name:LIAO
Suffix:
Gender:M
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 1:517 OLYMPIC WAY APT H
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7921
Mailing Address - Country:US
Mailing Address - Phone:510-717-5955
Mailing Address - Fax:
Practice Address - Street 1:517 OLYMPIC WAY APT H
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7921
Practice Address - Country:US
Practice Address - Phone:510-717-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42635225100000X
AZ11415225100000X
CA9408225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant