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Individual
MR. EDGARDO MESIAS LIVICA
Active
Individual
MR. EDGARDO MESIAS LIVICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
015653
NY
261QP2000X
Physical Therapy Clinic/Center
015653
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0129225
GHI
NY
05
—
02716585
—
NY
01
—
2558827
UNITED HEALTHCARE
NY
Enumeration date
09/25/2005
Last updated
05/24/2021
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