Provider Demographics
NPI:1437869229
Name:LIOU, JASON WEILUN (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WEILUN
Last Name:LIOU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 TOWN CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5900
Mailing Address - Country:US
Mailing Address - Phone:703-435-6604
Mailing Address - Fax:703-662-4506
Practice Address - Street 1:11166 FAIRFAX BLVD STE 105
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5025
Practice Address - Country:US
Practice Address - Phone:703-435-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist