Provider Demographics
NPI:1568551851
Name:LUO, LIYA (PT)
Entity Type:Individual
Prefix:
First Name:LIYA
Middle Name:
Last Name:LUO
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 1:170 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3725
Mailing Address - Country:US
Mailing Address - Phone:718-676-7344
Mailing Address - Fax:347-702-8577
Practice Address - Street 1:170 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3725
Practice Address - Country:US
Practice Address - Phone:718-676-7344
Practice Address - Fax:347-702-8577
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025290225100000X
NY025290-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025290-1OtherLICENSE#