Healthcare Provider Details

I. General information

NPI: 1821533316
Provider Name (Legal Business Name): INJURY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 ARLINGTON RD N
JACKSONVILLE FL
32211-5956
US

IV. Provider business mailing address

793 SANDPIPER LN
PONTE VEDRA FL
32082-2726
US

V. Phone/Fax

Practice location:
  • Phone: 904-425-9044
  • Fax: 904-425-9094
Mailing address:
  • Phone: 904-425-9044
  • Fax: 904-425-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ANTHONY LIVECCHI
Title or Position: OWNER
Credential: M.D.
Phone: 585-750-5348