Individual
JASON CORINTHIUS LIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2813 W SOUTHLAKE BLVD STE 110, SOUTHLAKE, TX 76092-6832
(817) 310-8780
Mailing address
732 PRINCETON DR, DESOTO, TX 75115-1435
(504) 813-4427
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2152500
TX
Other
Enumeration date
01/20/2020
Last updated
01/20/2020
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