Healthcare Provider Details

I. General information

NPI: 1205997137
Provider Name (Legal Business Name): LIVE WELL PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 RIVER RD SUITE 5
FAIR HAVEN NJ
07704-3267
US

IV. Provider business mailing address

623 RIVER RD SUITE 5
FAIR HAVEN NJ
07704-3267
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-5522
  • Fax: 732-842-2711
Mailing address:
  • Phone: 732-842-5522
  • Fax: 732-842-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE LIVINGSTON
Title or Position: OWNER
Credential: P.T.
Phone: 732-842-5522