Provider Demographics
NPI:1457666281
Name:LIVINGSTON, JAKE R (DPT)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:R
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N SMITH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2415
Mailing Address - Country:US
Mailing Address - Phone:847-934-7330
Mailing Address - Fax:847-934-7579
Practice Address - Street 1:220 N SMITH ST STE 100
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2415
Practice Address - Country:US
Practice Address - Phone:847-934-7330
Practice Address - Fax:847-934-7579
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist