Provider Demographics
NPI:1548794506
Name:LIU, EVANGELINE (DPT)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:JI
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:6980 MESA RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1563
Mailing Address - Country:US
Mailing Address - Phone:719-391-0044
Mailing Address - Fax:
Practice Address - Street 1:145 INVERNESS DR E STE 120
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5172
Practice Address - Country:US
Practice Address - Phone:720-324-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292942225100000X
COPTL.0016719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist