Provider Demographics
NPI:1851738462
Name:NEWELL, LIANA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:MARIE
Last Name:NEWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BELFAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8040
Mailing Address - Country:US
Mailing Address - Phone:803-629-1981
Mailing Address - Fax:803-825-4830
Practice Address - Street 1:108 BELFAIR RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8040
Practice Address - Country:US
Practice Address - Phone:803-629-1981
Practice Address - Fax:803-825-4830
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist