Provider Demographics
NPI:1649528894
Name:LIU, TIAN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:TIAN
Middle Name:
Last Name:LIU
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 1:10527 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2820
Mailing Address - Country:US
Mailing Address - Phone:510-375-0742
Mailing Address - Fax:510-525-3109
Practice Address - Street 1:10527 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2820
Practice Address - Country:US
Practice Address - Phone:510-375-0742
Practice Address - Fax:510-525-3109
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist