Individual
MRS. JESSICA ELIZABETH LIVENGOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1367
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2846675
—
OH
Enumeration date
12/14/2015
Last updated
08/25/2020
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