=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346372968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ANN LIVINGSTON RPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4650 W SUNSET BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-6062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-669-2568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11310 BLIX ST
-----------------------------------------------------
City | TOLUCA LAKE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91602-1209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-669-2568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT11544
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------