Provider Demographics
NPI:1821798646
Name:LIVINGSTON, IYESHIA PEARL
Entity Type:Individual
Prefix:
First Name:IYESHIA
Middle Name:PEARL
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 OLD SPARTANBURG RD APT 713
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4172
Mailing Address - Country:US
Mailing Address - Phone:864-350-3952
Mailing Address - Fax:
Practice Address - Street 1:4551 OLD SPARTANBURG RD APT 713
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4172
Practice Address - Country:US
Practice Address - Phone:864-350-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist