MEDICARE: MICHAEL ADAM LIVENGOOD LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8724	NC

General Provider Information

NPI Number	:	1003896879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ADAM LIVENGOOD LPT

Provider Business Mailing Address
First Line	:	232 SMITH CHAPEL RD
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1917
Country	:	US
Telephone Number	:	919-635-4500
Fax Number	:	919-635-4999

Provider Business Practice Location Address
First Line	:	232 SMITH CHAPEL RD
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1917
Country	:	US
Telephone Number	:	919-635-4500
Fax Number	:	919-635-4999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/23/2016

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