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Organization

LIVICA PHYSICAL THERAPY P.C.

Active
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Organization

LIVICA PHYSICAL THERAPY P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. EDGARDO MESIAS LIVICA R.P.T. (PRESIDENT/OWNER)
(718) 775-6025
Entity
Organization

Contact information

Practice address
2510 WESTCHESTER AVE, SUITE 106, BRONX, NY 10461-3512
(718) 775-6025
Mailing address
1577 LURTING AVE, BRONX, NY 10461-1509
(718) 822-8490

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
015653
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0050992
TOUCHSTONE
NY
01
0129225
GHI
NY
05
02716585
NY
01
2558827
UNITED HEALTHCARE
NY
01
P0P015653
METROPLUS
NY
Enumeration date
08/14/2007
Last updated
04/05/2011
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