Provider Demographics
NPI:1336501543
Name:LIANG, JUN
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:LIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E13858 COUNTY ROAD D
Mailing Address - Street 2:
Mailing Address - City:LA FARGE
Mailing Address - State:WI
Mailing Address - Zip Code:54639-8514
Mailing Address - Country:US
Mailing Address - Phone:608-632-0214
Mailing Address - Fax:
Practice Address - Street 1:715 HILL ST STE 250
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3572
Practice Address - Country:US
Practice Address - Phone:608-632-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10048-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist