Active NPI
David Liao Jr.
- Physical Therapy Assistant
- Detroit, MI
National Provider Identifier
1700402559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4802953
- Practice address
- 2102 Orleans St
Detroit, MI 48207-2769 - Phone
- (248) 577-2632
- NPI assigned
- Jun 17, 2020
- Last updated
- Jun 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 5502005126 | MI | |
| Physical Therapy Assistant | 225200000X | 4802953 | MI | Primary |
Addresses
Primary practice location
2102 Orleans St
Detroit, MI 48207-2769
Mailing address
27116 Townley St
Madison Heights, MI 48071-3379
Phone (734) 679-5351
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502005126 | MI | MD | Physical Medicine & Rehabilitation Physician |
| 4802953 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593302400000",
"number": "1700402559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27116 TOWNLEY ST",
"city": "MADISON HEIGHTS",
"state": "MI",
"postal_code": "480713379",
"telephone_number": "734-679-5351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2102 ORLEANS ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482072769",
"telephone_number": "248-577-2632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIAO",
"first_name": "DAVID",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-17",
"last_updated": "2020-06-28",
"certification_date": "2020-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MI",
"license": "5502005126",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "4802953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.