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 |