Provider Demographics
NPI:1457718264
Name:JOCELYN LIAN PEDIATRIC PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:JOCELYN LIAN PEDIATRIC PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:612-280-6065
Mailing Address - Street 1:13889 FAWN RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5035
Mailing Address - Country:US
Mailing Address - Phone:612-280-6065
Mailing Address - Fax:952-236-0800
Practice Address - Street 1:13889 FAWN RIDGE WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5035
Practice Address - Country:US
Practice Address - Phone:612-280-6065
Practice Address - Fax:952-236-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty