Healthcare Provider Details

I. General information

NPI: 1578074001
Provider Name (Legal Business Name): RONDA LIVINGSTON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RONDA FLEITES

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

IV. Provider business mailing address

2699 TIGERTAIL AVE APT 11
MIAMI FL
33133-4609
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8976
  • Fax:
Mailing address:
  • Phone: 786-402-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: