MEDICARE: LIVINGSTON PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0070HE	OTHER	TX	BCBS PAR PLAN
3	0070HE	OTHER	TX	BCBS PAR PLAN GROUP #

General Provider Information

NPI Number	:	1215930326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSTON PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	305 W MILL ST
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-3299
Country	:	US
Telephone Number	:	936-327-4084
Fax Number	:	936-327-1201

Provider Business Practice Location Address
First Line	:	305 W MILL ST
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-3299
Country	:	US
Telephone Number	:	936-327-4084
Fax Number	:	936-327-1201

Authorized Official
Title or Position	:	PRESIDENT, OWNER/P.T.
Name	:	MRS. JESSIE CLARKE
Credential	:	DPT
Telephone Number	:	936-327-4084

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/29/2026

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