Provider Demographics
NPI:1417721580
Name:LIVINGSTON, KENDALL MARIAH (LPTA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIAH
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SWIFT ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4296
Mailing Address - Country:US
Mailing Address - Phone:757-525-5473
Mailing Address - Fax:
Practice Address - Street 1:250 JOSEPHS DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3405
Practice Address - Country:US
Practice Address - Phone:757-272-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606451225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant