Provider Demographics
NPI:1053768135
Name:LIU-KEBAILI, JESSICA L (LMT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:LIU-KEBAILI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 JERMAE STREET
Mailing Address - Street 2:
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788
Mailing Address - Country:US
Mailing Address - Phone:240-440-1094
Mailing Address - Fax:
Practice Address - Street 1:3200 WEEPING WILLOW CT APT 42
Practice Address - Street 2:
Practice Address - City:ASPEN HILL
Practice Address - State:MD
Practice Address - Zip Code:20906-2567
Practice Address - Country:US
Practice Address - Phone:240-440-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01808225700000X
DCM225700000X
VA0019014538225700000X
DCMT2020225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist