Provider Demographics
NPI:1407971989
Name:LIVINGWELL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LIVINGWELL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOVINA
Authorized Official - Middle Name:TRAMEL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-772-4001
Mailing Address - Street 1:1400 MERCANTILE LN
Mailing Address - Street 2:SUITE 184
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5341
Mailing Address - Country:US
Mailing Address - Phone:301-772-4001
Mailing Address - Fax:301-773-4003
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:SUITE 184
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-772-4001
Practice Address - Fax:301-773-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty