Provider Demographics
NPI:1336416122
Name:LI, LI (DPT)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SOUTH ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2847
Mailing Address - Country:US
Mailing Address - Phone:617-833-8835
Mailing Address - Fax:617-695-2379
Practice Address - Street 1:100 BEACH ST
Practice Address - Street 2:FLOOR # 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2509
Practice Address - Country:US
Practice Address - Phone:617-833-8835
Practice Address - Fax:617-695-2379
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist