Provider Demographics
NPI:1700094828
Name:LIAGA, COLLEEN MARIE (PT, OCS)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:LIAGA
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23639 BELLA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9228
Mailing Address - Country:US
Mailing Address - Phone:951-277-7840
Mailing Address - Fax:
Practice Address - Street 1:23639 BELLA VISTA RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-9228
Practice Address - Country:US
Practice Address - Phone:951-277-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist