Provider Demographics
NPI:1740676204
Name:LIOTTA, PHIL
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:LIOTTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 COLLEGE LN
Mailing Address - Street 2:APT 12
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-9149
Mailing Address - Country:US
Mailing Address - Phone:240-423-4921
Mailing Address - Fax:
Practice Address - Street 1:706 COLLEGE LN
Practice Address - Street 2:APT 12
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-9149
Practice Address - Country:US
Practice Address - Phone:240-423-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer