Provider Demographics
NPI:1538141452
Name:LIU, AMY Q (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:Q
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:QIN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10220 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9332
Mailing Address - Country:US
Mailing Address - Phone:561-753-5610
Mailing Address - Fax:561-795-8653
Practice Address - Street 1:10220 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9332
Practice Address - Country:US
Practice Address - Phone:561-753-5610
Practice Address - Fax:561-795-8653
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101076208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH48362Medicare UPIN
IN899980SMedicare PIN