Provider Demographics
NPI:1225334626
Name:LIVINGSTON, CANDI (PTA)
Entity Type:Individual
Prefix:
First Name:CANDI
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GREEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-3171
Mailing Address - Country:US
Mailing Address - Phone:501-944-4336
Mailing Address - Fax:
Practice Address - Street 1:9880 BROCKINGTON RD
Practice Address - Street 2:SUITE 147
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3585
Practice Address - Country:US
Practice Address - Phone:501-944-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist