Provider Demographics
NPI:1407974728
Name:LIU, VICTORIA (PT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 OLIVER PL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1380
Mailing Address - Country:US
Mailing Address - Phone:917-776-5378
Mailing Address - Fax:
Practice Address - Street 1:8806 OLIVER PL
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1380
Practice Address - Country:US
Practice Address - Phone:917-776-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT274832251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 27489OtherPT LICENSE