Provider Demographics
NPI:1861007486
Name:NEWBERG, LIAM (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:LIAM
Middle Name:
Last Name:NEWBERG
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22923 MARIANO ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6133
Mailing Address - Country:US
Mailing Address - Phone:818-223-1187
Mailing Address - Fax:
Practice Address - Street 1:22923 MARIANO ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6133
Practice Address - Country:US
Practice Address - Phone:818-223-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist