| NPI | 1588905731 |
|---|---|
| Former Name | ELISE MARIE LIVENGOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.019120) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: IL 070.019120) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2013-03-13 |