Provider Demographics
NPI:1821533316
Name:INJURY INSTITUTE LLC
Entity Type:Organization
Organization Name:INJURY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LIVECCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-750-5348
Mailing Address - Street 1:793 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2726
Mailing Address - Country:US
Mailing Address - Phone:904-425-9044
Mailing Address - Fax:904-425-9094
Practice Address - Street 1:944 ARLINGTON RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5956
Practice Address - Country:US
Practice Address - Phone:904-425-9044
Practice Address - Fax:904-425-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01892222Medicaid
G73656Medicare UPIN