Provider Demographics
NPI:1073203840
Name:LIVICA, EENA KAELA CIMANES (PT, ATC, CSCS, RYT)
Entity Type:Individual
Prefix:
First Name:EENA KAELA
Middle Name:CIMANES
Last Name:LIVICA
Suffix:
Gender:F
Credentials:PT, ATC, CSCS, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 LURTING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1509
Mailing Address - Country:US
Mailing Address - Phone:347-612-3157
Mailing Address - Fax:
Practice Address - Street 1:1577 LURTING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1509
Practice Address - Country:US
Practice Address - Phone:347-612-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist