Provider Demographics
NPI:1639462492
Name:LIVINGSTON, JERMAINE LAKEITH (PTA)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:LAKEITH
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 TREE CROSSINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4044
Mailing Address - Country:US
Mailing Address - Phone:205-215-4239
Mailing Address - Fax:
Practice Address - Street 1:80 HIGHWAY 304
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-5551
Practice Address - Country:US
Practice Address - Phone:205-668-6800
Practice Address - Fax:205-668-2677
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant