Provider Demographics
NPI:1942427604
Name:LIEUW, CHRISTOPHER JASON (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER JASON
Middle Name:
Last Name:LIEUW
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:MR
Other - First Name:C JASON
Other - Middle Name:
Other - Last Name:LIEUW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:1619 SW 49TH ST
Mailing Address - Street 2:APT 42
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3006
Mailing Address - Country:US
Mailing Address - Phone:650-302-2015
Mailing Address - Fax:
Practice Address - Street 1:114 GILL COLISEUM
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8547
Practice Address - Country:US
Practice Address - Phone:541-737-0935
Practice Address - Fax:541-737-0864
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer