Provider Demographics
NPI:1346382025
Name:LIVINGSTON, MARIBETH LYNNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:LYNNE
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 1:61 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-4113
Mailing Address - Country:US
Mailing Address - Phone:518-237-3655
Mailing Address - Fax:
Practice Address - Street 1:1 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1754
Practice Address - Country:US
Practice Address - Phone:518-273-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0049331225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant