Provider Demographics
NPI:1851625917
Name:LI, SHIAO-LAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:SHIAO-LAN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18102 SKY PARK CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6531
Mailing Address - Country:US
Mailing Address - Phone:949-333-2224
Mailing Address - Fax:949-333-2225
Practice Address - Street 1:18102 SKY PARK CIR
Practice Address - Street 2:SUITE D
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6531
Practice Address - Country:US
Practice Address - Phone:949-333-2224
Practice Address - Fax:949-333-2225
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EI102ZMedicare PIN