Healthcare Provider Details

I. General information

NPI: 1275880130
Provider Name (Legal Business Name): MICHAEL A LIVOTI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 KNOTTS POINTE LN STE 103
SUFFOLK VA
23435-1135
US

IV. Provider business mailing address

PO BOX 412307
BOSTON MA
02241-2307
US

V. Phone/Fax

Practice location:
  • Phone: 757-530-4011
  • Fax: 757-918-4538
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207573
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: