Provider Demographics
NPI:1407105539
Name:LIAO, YAN (LMT ABMB)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:LMT ABMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8145
Mailing Address - Country:US
Mailing Address - Phone:703-383-0338
Mailing Address - Fax:703-383-0322
Practice Address - Street 1:4242 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8145
Practice Address - Country:US
Practice Address - Phone:703-383-0338
Practice Address - Fax:703-383-0322
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist