Provider Demographics
NPI:1811476807
Name:LIU, CONNIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:LIU
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 1:1535 COLT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1909
Mailing Address - Country:US
Mailing Address - Phone:323-695-8711
Mailing Address - Fax:
Practice Address - Street 1:275 HOSPITAL PKWY FL 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1106
Practice Address - Country:US
Practice Address - Phone:408-972-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist