Provider Demographics
NPI:1306399506
Name:LIANG, GENESIRMAN (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:GENESIRMAN
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:LIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:19572 TURTLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3809
Mailing Address - Country:US
Mailing Address - Phone:818-606-4119
Mailing Address - Fax:
Practice Address - Street 1:19572 TURTLE RIDGE LN
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-3809
Practice Address - Country:US
Practice Address - Phone:818-606-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist