Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1367 | NH |
NPI | 1013382217 |
---|---|
Provider Name | Mrs. Jessica Elizabeth Livengood |
First Address | Concord, NH 03301-6419 |
Second Address | Westerville, OH 43081-2890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2015 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2846675 | (05) | OH |