Provider Demographics
NPI:1205545001
Name:LI, MUHAN LILY (LMBT)
Entity type:Individual
Prefix:MISS
First Name:MUHAN
Middle Name:LILY
Last Name:LI
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:MISS
Other - First Name:MUHAN
Other - Middle Name:LILY
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT
Mailing Address - Street 1:400 BELGIAN DR
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-8055
Mailing Address - Country:US
Mailing Address - Phone:704-798-8929
Mailing Address - Fax:
Practice Address - Street 1:10468 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3274
Practice Address - Country:US
Practice Address - Phone:704-798-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19128225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty